Provider Demographics
NPI:1871765008
Name:BALDWIN OPTICAL
Entity type:Organization
Organization Name:BALDWIN OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:YUN
Authorized Official - Middle Name:KOL
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:251-943-1758
Mailing Address - Street 1:310 E LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2618
Mailing Address - Country:US
Mailing Address - Phone:251-943-1758
Mailing Address - Fax:251-943-7999
Practice Address - Street 1:310 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2618
Practice Address - Country:US
Practice Address - Phone:251-943-1758
Practice Address - Fax:251-943-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0442270001Medicare NSC