Provider Demographics
NPI:1558780973
Name:BAKER, DANE (OD)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:
Last Name:BAKER
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 1:1115 S HEMLOCK ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3800
Mailing Address - Country:US
Mailing Address - Phone:906-774-6288
Mailing Address - Fax:
Practice Address - Street 1:1115 S HEMLOCK ST
Practice Address - Street 2:SUITE 5
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3800
Practice Address - Country:US
Practice Address - Phone:906-282-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004826152W00000X
MI5330001155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist