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General NPI Number Information
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NPI Number | 1205329653
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Entity Type | Individual
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Provider Name | JODI PEDERSON BAKER OD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 2024 GUNTER AVE
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City | GUNTERSVILLE
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State | AL
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Zip | 35976-2113
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Country | US
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Telephone | 256-293-5181
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 HONEYCOMB RD
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City | GRANT
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State | AL
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Zip | 35747-9387
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | S-E04
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License Number State | AL
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