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General NPI Number Information
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NPI Number | 1619441482
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Entity Type | Organization
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Legal Business Name | ASHLEY BAKER OD LLC
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 6045 HAGEN RANCH RD STE 5
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City | LAKE WORTH
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State | FL
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Zip | 33467-7251
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Country | US
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Telephone | 561-324-5206
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Fax |
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Provider Business Mailing Address
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Address Line | 236 OLD COUNTRY RD S
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City | WELLINGTON
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State | FL
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Zip | 33414-4828
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Country | US
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Telephone | 561-324-5206
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | ASHLEY BAKER
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Credential | OD
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Telephone | 561-324-5206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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