Healthcare Provider Details

I. General information

NPI: 1053191908
Provider Name (Legal Business Name): ZOE BAKER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 HOLLY AVE NE
ALBUQUERQUE NM
87113-2474
US

IV. Provider business mailing address

6401 HOLLY AVE NE
ALBUQUERQUE NM
87113-2474
US

V. Phone/Fax

Practice location:
  • Phone: 505-355-2020
  • Fax:
Mailing address:
  • Phone: 505-355-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-2023-0011
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: