Provider Demographics
NPI:1043211477
Name:BAIRD, CHANNING A (OD, INC)
Entity Type:Individual
Prefix:
First Name:CHANNING
Middle Name:A
Last Name:BAIRD
Suffix:
Gender:F
Credentials:OD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 S GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4635
Mailing Address - Country:US
Mailing Address - Phone:303-282-5427
Mailing Address - Fax:303-282-5430
Practice Address - Street 1:1061 S GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4635
Practice Address - Country:US
Practice Address - Phone:303-282-5427
Practice Address - Fax:303-282-5430
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC48343Medicare PIN
COU59639Medicare UPIN