1851411276 NPI number — ARNEL R BAIRD

Table of content: (NPI 1851411276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851411276 NPI number — ARNEL R BAIRD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARNEL R BAIRD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
20 20 OPTICAL & VISION CENTER, PLLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851411276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11670 N 15TH E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IDAHO FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83401-5111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-542-9155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 S 4TH AVE
Provider Second Line Business Practice Location Address:
C-2
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-6462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-637-0841
Provider Business Practice Location Address Fax Number:
208-237-6922
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAIRD
Authorized Official First Name:
ARNEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-542-9155

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  ID ODP801 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50065 . This is a "DAVIS VISION" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 130136 . This is a "NATIONAL VISION ADMIN." identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: V6986 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 2276103 . This is a "FIRST HEALTH" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: ID 0801 . This is a "EYEMED" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: ID 00801 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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