Provider Demographics
NPI:1508366584
Name:BAKER, KALIE MARIE (OD)
Entity Type:Individual
Prefix:MRS
First Name:KALIE
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:KALIE
Other - Middle Name:MARIE
Other - Last Name:MCCARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2614 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:323-282-2811
Mailing Address - Fax:323-588-1124
Practice Address - Street 1:2790 SKYPARK DR STE 115
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5331
Practice Address - Country:US
Practice Address - Phone:530-638-5681
Practice Address - Fax:424-407-3309
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33875TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist