Provider Demographics
NPI:1336125244
Name:BAER, MARTIN J (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:BAER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4135
Mailing Address - Country:US
Mailing Address - Phone:781-935-1025
Mailing Address - Fax:781-933-6110
Practice Address - Street 1:65 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4135
Practice Address - Country:US
Practice Address - Phone:781-935-1025
Practice Address - Fax:781-933-6110
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300713Medicaid
MA0041854OtherAETNA INSURANCE CO.
MA717364OtherTUFTS HEALTH PLAN
MAW20029OtherBLUE CROSS
MAT91844Medicare UPIN
MA226058Medicare ID - Type Unspecified