Healthcare Provider Details

I. General information

NPI: 1588846026
Provider Name (Legal Business Name): ALLAN BAKER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4917 DIXIE HWY STE H
LOUISVILLE KY
40216-2565
US

IV. Provider business mailing address

4036 DUTCHMANS LN
LOUISVILLE KY
40207-4704
US

V. Phone/Fax

Practice location:
  • Phone: 502-447-2020
  • Fax: 502-447-3083
Mailing address:
  • Phone: 502-895-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License NumberKY27
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: STEVEN A BAKER
Title or Position: PRESIDENT
Credential: LDO
Phone: 502-895-2020