Provider Demographics
NPI:1376782565
Name:T M BAKER, OD INC.
Entity Type:Organization
Organization Name:T M BAKER, OD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-453-0900
Mailing Address - Street 1:118 E SHAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-2820
Mailing Address - Country:US
Mailing Address - Phone:918-453-0900
Mailing Address - Fax:918-453-0241
Practice Address - Street 1:118 E SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2820
Practice Address - Country:US
Practice Address - Phone:918-453-0900
Practice Address - Fax:918-453-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100760230AMedicaid
OKOKB5427Medicare PIN
OK100760230AMedicaid