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General NPI Number Information
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NPI Number | 1902946056
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Entity Type | Individual
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Provider Name | TERRY RICHARD BAKER OD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 2300 SAGAMORE PARKWAY S
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City | LAFAYETTE
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State | IN
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Zip | 47904
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Country | US
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Telephone | 765-471-1515
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Fax | 765-471-1453
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Provider Business Mailing Address
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Address Line | 2300 SAGAMORE PARKWAY S
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City | LAFAYETTE
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State | IN
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Zip | 47904
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Country | US
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Telephone | 765-471-1515
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Fax | 765-471-1453
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 18001878A
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License Number State | IN
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