Provider Demographics
NPI:1578519633
Name:BAKER, EMILY JANE (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
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 1:1995 E COALTON RD
Mailing Address - Street 2:#81-301
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4419
Mailing Address - Country:US
Mailing Address - Phone:303-653-4599
Mailing Address - Fax:303-466-5483
Practice Address - Street 1:500 SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8219
Practice Address - Country:US
Practice Address - Phone:303-466-3845
Practice Address - Fax:303-466-5483
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist