Provider Demographics
NPI:1063556116
Name:BAIRD, ARNEL ROY (OD)
Entity type:Individual
Prefix:DR
First Name:ARNEL
Middle Name:ROY
Last Name:BAIRD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11670 N 15TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5111
Mailing Address - Country:US
Mailing Address - Phone:208-542-9155
Mailing Address - Fax:
Practice Address - Street 1:301 S 4TH AVE
Practice Address - Street 2:C-2
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6462
Practice Address - Country:US
Practice Address - Phone:208-637-0841
Practice Address - Fax:208-237-6922
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID-801152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist