Provider Demographics
NPI:1124201744
Name:DONALD L. BAKER
Entity Type:Organization
Organization Name:DONALD L. BAKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-754-3309
Mailing Address - Street 1:210 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-3010
Mailing Address - Country:US
Mailing Address - Phone:479-754-3309
Mailing Address - Fax:479-754-3955
Practice Address - Street 1:210 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3010
Practice Address - Country:US
Practice Address - Phone:479-754-3309
Practice Address - Fax:479-754-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2006332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0298930001Medicare NSC