Provider Demographics
NPI:1386681724
Name:BAXTER, DAVID B (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:BAXTER
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:PO BOX 12490
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2490
Mailing Address - Country:US
Mailing Address - Phone:252-637-2921
Mailing Address - Fax:252-637-1863
Practice Address - Street 1:3000 TRENT RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5735
Practice Address - Country:US
Practice Address - Phone:252-637-2921
Practice Address - Fax:252-637-1863
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09053OtherBCBS PROVIDER
NC0423340001Medicare NSC
NC246301Medicare PIN
NC09053OtherBCBS PROVIDER