Provider Demographics
NPI:1497874267
Name:BAIRD, THEODORE THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:THOMAS
Last Name:BAIRD
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 1:915 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3617
Mailing Address - Country:US
Mailing Address - Phone:814-941-4849
Mailing Address - Fax:
Practice Address - Street 1:6676 SMITHFIELD TOWNE CENTER
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652
Practice Address - Country:US
Practice Address - Phone:814-643-6190
Practice Address - Fax:814-643-6191
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007125T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist