Provider Demographics
NPI:1134289507
Name:BAGGS, ERIC GLENN (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:GLENN
Last Name:BAGGS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:6140 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1933
Practice Address - Country:US
Practice Address - Phone:918-252-2020
Practice Address - Fax:918-307-1983
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762750AMedicaid
OK100762750AMedicaid
OKUO5668Medicare UPIN