Provider Demographics
NPI:1083083240
Name:CHANNING A BAIRD OD, INC
Entity Type:Organization
Organization Name:CHANNING A BAIRD OD, INC
Other - Org Name:EYES OF THE WORLD OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANNING
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-282-5427
Mailing Address - Street 1:2036 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1106
Mailing Address - Country:US
Mailing Address - Phone:303-282-5427
Mailing Address - Fax:303-484-3367
Practice Address - Street 1:2036 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1106
Practice Address - Country:US
Practice Address - Phone:303-282-5427
Practice Address - Fax:303-484-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU59639Medicare UPIN