Provider Demographics
NPI:1073516753
Name:BAALS, GREY PRESTON (OD)
Entity Type:Individual
Prefix:DR
First Name:GREY
Middle Name:PRESTON
Last Name:BAALS
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:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0549
Mailing Address - Country:US
Mailing Address - Phone:260-569-9550
Mailing Address - Fax:260-569-9244
Practice Address - Street 1:712 CAMERON WOODS DR
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703
Practice Address - Country:US
Practice Address - Phone:260-668-3937
Practice Address - Fax:260-668-3794
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000092385OtherANTHEM BCBS
IN100225740Medicaid
INP01201641OtherRAILROAD MEDICARE
IN000000092385OtherANTHEM BCBS
IN771660AMedicare PIN
IN160450025Medicare PIN
INP01201641OtherRAILROAD MEDICARE
INM400074904Medicare PIN
IN100225740Medicaid