Provider Demographics
NPI:1497935274
Name:BAKER, MARJAN (OD)
Entity Type:Individual
Prefix:
First Name:MARJAN
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3182 KIRK RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2442
Mailing Address - Country:US
Mailing Address - Phone:650-278-0330
Mailing Address - Fax:925-226-3935
Practice Address - Street 1:3182 KIRK RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2442
Practice Address - Country:US
Practice Address - Phone:650-278-0330
Practice Address - Fax:925-226-3935
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist