Provider Demographics
NPI:1487621280
Name:BAKER, BRIAN K (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
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 1:3750 CLEMMONS RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8499
Mailing Address - Country:US
Mailing Address - Phone:336-766-9118
Mailing Address - Fax:
Practice Address - Street 1:3750 CLEMMONS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8499
Practice Address - Country:US
Practice Address - Phone:336-766-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU77261Medicare UPIN
NC2471712Medicare ID - Type UnspecifiedOPTOMETRIST
NC0177170001Medicare NSC