Provider Demographics
NPI:1841340361
Name:BAKER, THOMAS EUGENE I (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EUGENE
Last Name:BAKER
Suffix:I
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 1:4721 COLLBRAN CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-4334
Mailing Address - Country:US
Mailing Address - Phone:260-486-2020
Mailing Address - Fax:
Practice Address - Street 1:1318 MINNICH RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-2052
Practice Address - Country:US
Practice Address - Phone:260-749-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002262B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5612520001Medicare NSC
IN258690AMedicare PIN
INU28720Medicare UPIN