Provider Demographics
NPI:1427287598
Name:BAKER, ALEX (OD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ALEXANDER
Other - Middle Name:LYLE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2019 ANDERSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0773
Mailing Address - Country:US
Mailing Address - Phone:530-756-5050
Mailing Address - Fax:530-204-5995
Practice Address - Street 1:2019 ANDERSON RD STE C
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0773
Practice Address - Country:US
Practice Address - Phone:530-756-5050
Practice Address - Fax:530-204-5995
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB563YOtherMEDICARE PTAN