Provider Demographics
NPI:1265677405
Name:MICHAEL E BALDWIN OD PC
Entity Type:Organization
Organization Name:MICHAEL E BALDWIN OD PC
Other - Org Name:EASTSIDE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-268-4204
Mailing Address - Street 1:2411 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2923
Mailing Address - Country:US
Mailing Address - Phone:864-268-4204
Mailing Address - Fax:864-268-4244
Practice Address - Street 1:2411 HUDSON RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2923
Practice Address - Country:US
Practice Address - Phone:864-268-4204
Practice Address - Fax:864-268-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4872890001Medicare NSC