Provider Demographics
NPI:1366577751
Name:BAKER, ALLEN WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:WAYNE
Last Name:BAKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15972 SW TUALATIN SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8690
Mailing Address - Country:US
Mailing Address - Phone:503-625-5665
Mailing Address - Fax:503-625-3556
Practice Address - Street 1:15972 SW TUALATIN SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-8690
Practice Address - Country:US
Practice Address - Phone:503-625-5665
Practice Address - Fax:503-625-3556
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1885ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR083068Medicaid
OR083068Medicaid