MEDICARE: DR. JOSHUA CHARLES BAKER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2481	CO
2	152W00000X	Optometrist	1893	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	#OPT - 2481	OTHER	CO	OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1538138227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA CHARLES BAKER O.D.

Provider Business Mailing Address
First Line	:	5865 W UTOPIA RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5251
Country	:	US
Telephone Number	:	623-572-3941
Fax Number	:

Provider Business Practice Location Address
First Line	:	5865 W UTOPIA RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5251
Country	:	US
Telephone Number	:	623-572-3941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	08/04/2015

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