Provider Demographics
NPI:1417202250
Name:BAIRD, LUCAS R (OD)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:R
Last Name:BAIRD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:LUKE
Other - Middle Name:
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1570 EGYPT RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1183
Mailing Address - Country:US
Mailing Address - Phone:610-650-6888
Mailing Address - Fax:610-650-0007
Practice Address - Street 1:1570 EGYPT RD STE 250
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1183
Practice Address - Country:US
Practice Address - Phone:610-650-6888
Practice Address - Fax:610-650-0007
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027414420014Medicaid