Provider Demographics
NPI:1962579599
Name:BAXTER, DAVIDA A (OD)
Entity type:Individual
Prefix:
First Name:DAVIDA
Middle Name:A
Last Name:BAXTER
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:9004 FOREST XING
Mailing Address - Street 2:STE A
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1193
Mailing Address - Country:US
Mailing Address - Phone:281-364-1981
Mailing Address - Fax:281-296-2490
Practice Address - Street 1:9004 FOREST XING
Practice Address - Street 2:STE A
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1193
Practice Address - Country:US
Practice Address - Phone:281-364-1981
Practice Address - Fax:281-296-2490
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX2687TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
760568241OtherTIN
TX8L20952Medicare PIN