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NPI Code Detail

MEDICARE: ANGIE PRUITT BAKER O.D.

MEDICARE: ANGIE PRUITT BAKER O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2466OK

General Provider Information

NPI Number : 1679561542
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGIE PRUITT BAKER O.D.
Provider Business Mailing Address
First Line : 1509 LITTLE KITTEN AVE
Second Line :
City : MANHATTAN
State : KS
Zip : 66503-7578
Country : US
Telephone Number : 785-313-2796
Fax Number :
Provider Business Practice Location Address
First Line : 8072 NORMANDY DR
Second Line :
City : FORT RILEY
State : KS
Zip : 66442-7069
Country : US
Telephone Number : 785-240-5516
Fax Number : 785-239-4065
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 02/11/2021

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