1174630677 NPI number — ALLAN BAKER INC

Table of content: (NPI 1174630677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174630677 NPI number — ALLAN BAKER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLAN BAKER INC
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:
KORRECT OPTICAL
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:
1174630677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 BISHOP LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40218-2905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-895-2020
Provider Business Mailing Address Fax Number:
502-657-4979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4036 DUTCHMANS LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-895-2020
Provider Business Practice Location Address Fax Number:
502-657-4979
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
502-897-1656

Provider Taxonomy Codes

  • Taxonomy code: 156FX1100X , with the licence number:  KY27 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 16739 . This is a "DUPONT SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16740 . This is a "DIXIE SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40676 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9120628792 . This is a "DUPONT PASSPORT BLOCK" identifier . This identifiers is of the category "OTHER".
  • Identifier: K1411506 . This is a "DIXIE CLARITY VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14602 . This is a "CVILLE SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52900271 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: KY0027 . This is a "DUPONT EYE MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22285 . This is a "PIN # AVESIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: K1411522 . This is a "CVILLE CLARITY VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: K0247795 . This is a "DUPONT CLARITY VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000210920 . This is a "CVILLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000213527 . This is a "DUPONT ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000213814 . This is a "DIXIE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00648 . This is a "VEN # AVESIS" identifier . This identifiers is of the category "OTHER".




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