=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497874267
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THEODORE THOMAS BAIRD O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6676 SMITHFIELD TOWNE CENTER
-----------------------------------------------------
City | HUNTINGDON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-643-6190
-----------------------------------------------------
Fax | 814-643-6191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 28TH AVE
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16601-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-941-4849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OE007125T
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------