Provider Demographics
NPI:1508979808
Name:JOHN C BAER MD LLC
Entity Type:Organization
Organization Name:JOHN C BAER MD LLC
Other - Org Name:SOUTH PENN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-632-6063
Mailing Address - Street 1:250 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2534
Mailing Address - Country:US
Mailing Address - Phone:717-632-6063
Mailing Address - Fax:717-632-8337
Practice Address - Street 1:250 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2534
Practice Address - Country:US
Practice Address - Phone:717-632-6063
Practice Address - Fax:717-632-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE001116152WC0802X
MDTA0952152WC0802X
PAMD418856207W00000X
PAMD06890L207W00000X
MDD0029740207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01399171OtherHIGHMARK BLUE SHIELD
MD3821719OtherAETNA
PA50000869OtherCAPITAL BLUE CROSS
PADA3122OtherRAILROAD MEDICARE
MDT274OtherCAREFIRST BSBC NAT CAP AR
MDDA3126OtherRAILROAD MEDICARE
PAJO1414870OtherHIGHMARK BS OPTOMETRY GRP
MDT274OtherCAREFIRST BLUE CHOICE
MD1308JCOtherCAREFIRST BCBS
PA4121977OtherAETNA PPO
PA3190310OtherAETNA HMO
MD433851101OtherMEDICAID OPTICS LTD LOCA
PA10077025800004Medicaid
PA1007705800005OtherMEDICAID OPTOMETRY GROUP
MD433851100Medicaid
PA50000869OtherKEYSTONE HPC
PA1007705800005OtherMEDICAID OPTOMETRY GROUP
MD1308JCOtherCAREFIRST BCBS