Provider Demographics
NPI:1871747675
Name:BAKER EYE CARE, O.D., PA
Entity type:Organization
Organization Name:BAKER EYE CARE, O.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-766-9118
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-0345
Mailing Address - Country:US
Mailing Address - Phone:336-766-9118
Mailing Address - Fax:336-766-8708
Practice Address - Street 1:3750 CLEMMONS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8499
Practice Address - Country:US
Practice Address - Phone:336-766-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6194520001Medicare NSC
NC2471712BMedicare PIN