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General NPI Number Information
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NPI Number | 1013051333
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Entity Type | Organization
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Legal Business Name | LEONARD AND SHELBY BAKER PTR
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 17 W BROAD ST
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City | BURLINGTON
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State | NJ
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Zip | 08016-4413
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Country | US
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Telephone | 609-386-0352
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Fax | 609-386-3702
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Provider Business Mailing Address
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Address Line | 17 W BROAD ST
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City | BURLINGTON
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State | NJ
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Zip | 08016-4413
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Country | US
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Telephone | 609-386-0352
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Fax | 609-386-3702
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Authorized Official
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Title or Position | PARTNER
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Name | DR. SHELBY ALAN BAKER
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Credential | O.D.
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Telephone | 609-386-0352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00375000
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License Number State | NJ
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