Provider Demographics
NPI:1124365739
Name:BAKER, STEVEN (LDO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:A
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LDO
Mailing Address - Street 1:3801 BISHOP LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2905
Mailing Address - Country:US
Mailing Address - Phone:502-897-1656
Mailing Address - Fax:
Practice Address - Street 1:4036 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4704
Practice Address - Country:US
Practice Address - Phone:502-895-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1259156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY52900271Medicaid
KY52900271Medicaid
KYU91753Medicare UPIN