Healthcare Provider Details

I. General information

NPI: 1154398253
Provider Name (Legal Business Name): CARL W BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LAFAYETTE PL STE C
HILTON HEAD ISLAND SC
29926-2277
US

IV. Provider business mailing address

15 LAFAYETTE PL STE C
HILTON HEAD ISLAND SC
29926-2277
US

V. Phone/Fax

Practice location:
  • Phone: 843-715-2424
  • Fax: 843-715-2945
Mailing address:
  • Phone: 843-715-2424
  • Fax: 843-715-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number17421
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number32965
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number32965
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number17421
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: