Provider Demographics
NPI:1043352255
Name:BAGGETT, DAN ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:ALAN
Last Name:BAGGETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1605
Mailing Address - Country:US
Mailing Address - Phone:650-617-2020
Mailing Address - Fax:650-617-4550
Practice Address - Street 1:456 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1605
Practice Address - Country:US
Practice Address - Phone:650-617-2020
Practice Address - Fax:650-617-4550
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5985T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10191Medicare UPIN
CASD0059851Medicare PIN