Provider Demographics
NPI:1275622532
Name:BAIRD, BRIAN O (O D)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:O
Last Name:BAIRD
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13945 W GRAND AVE
Mailing Address - Street 2:SUITE A101
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-931-2943
Mailing Address - Fax:623-583-2253
Practice Address - Street 1:13945 W GRAND AVE
Practice Address - Street 2:SUITE A101
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-931-2943
Practice Address - Fax:623-582-2253
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1514152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ114634Medicare PIN
U85593Medicare UPIN