Provider Demographics
NPI:1235149311
Name:BAIRD, BRIAN S (OD PC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:BAIRD
Suffix:
Gender:M
Credentials:OD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12921 PLYMOUTH GOSHEN TRL
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-7916
Mailing Address - Country:US
Mailing Address - Phone:574-936-3212
Mailing Address - Fax:574-936-3481
Practice Address - Street 1:12921 PLYMOUTH GOSHEN TRL
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-7916
Practice Address - Country:US
Practice Address - Phone:574-936-3212
Practice Address - Fax:574-936-3481
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU33158Medicare UPIN
IN254090AMedicare PIN