Healthcare Provider Details

I. General information

NPI: 1558591321
Provider Name (Legal Business Name): SCOTT BAKER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 03/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 CROSSROADS BLVD
COLD SPRING KY
41042
US

IV. Provider business mailing address

7241 W KINGS AVE
PEORIA AZ
85382-4948
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-9464
  • Fax:
Mailing address:
  • Phone: 937-371-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5839
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1831DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: