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General NPI Number Information
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NPI Number | 1336256288
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Entity Type | Individual
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Provider Name | SHELLY D BAKER OD
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Gender | Female
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 1252 W LAKESHORE DR
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City | MANISTIQUE
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State | MI
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Zip | 49854-1364
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Country | US
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Telephone | 906-341-3933
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Fax | 906-341-3944
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Provider Business Mailing Address
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Address Line | 1252 W LAKESHORE DR
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City | MANISTIQUE
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State | MI
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Zip | 49854-1364
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Country | US
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Telephone | 906-341-3933
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Fax | 906-341-3944
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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 | 4901003805
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License Number State | MI
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