Provider Demographics
NPI:1912928516
Name:BALDWIN, JASON FRANKLIN (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:FRANKLIN
Last Name:BALDWIN
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 1:4850 ENCORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-6013
Mailing Address - Country:US
Mailing Address - Phone:989-772-1704
Mailing Address - Fax:
Practice Address - Street 1:4850 ENCORE BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-6013
Practice Address - Country:US
Practice Address - Phone:989-772-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004373152W00000X
SC1510152W00000X
IN18003718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201066910Medicaid
IN201066910Medicaid
INM400070673Medicare PIN
INP01117354Medicare PIN
INM400037168Medicare PIN
IN160450021Medicare PIN