1467629618 NPI number — BAKER EYE ASSOCIATES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467629618 NPI number — BAKER EYE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAKER EYE ASSOCIATES, PC
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:
Provider Other Organization Name Type Code:
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:
1467629618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 LOCUST ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
DANVERS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01923-2239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-376-1637
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 LOCUST ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DANVERS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01923-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-376-1637
Provider Business Practice Location Address Fax Number:
978-304-0413
Provider Enumeration Date:
05/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
DEARBORN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-376-1637

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3075 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0353027 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110072761A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: D09427 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: W20157 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: W15607 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com