Provider Demographics
NPI:1497817159
Name:BAKER OPTICIANS
Entity Type:Organization
Organization Name:BAKER OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:406-586-4701
Mailing Address - Street 1:300 N WILLSON AVE
Mailing Address - Street 2:#201-B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3551
Mailing Address - Country:US
Mailing Address - Phone:406-586-4701
Mailing Address - Fax:406-586-4702
Practice Address - Street 1:300 N WILLSON AVE
Practice Address - Street 2:#201-B
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3551
Practice Address - Country:US
Practice Address - Phone:406-586-4701
Practice Address - Fax:406-586-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT06-00055785332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT29630OtherBLUE CROSS BLUE SHIELD
MT29630OtherBLUE CROSS BLUE SHIELD