Provider Demographics
NPI:1619039864
Name:BAAS, NATHAN G (OD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:G
Last Name:BAAS
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 1:515 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3246
Mailing Address - Country:US
Mailing Address - Phone:231-946-0333
Mailing Address - Fax:231-946-1665
Practice Address - Street 1:515 S UNION ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3246
Practice Address - Country:US
Practice Address - Phone:231-946-0333
Practice Address - Fax:231-946-1665
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINB004139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944770039Medicaid
MI900B811100OtherBCBS
MI944717597Medicaid
MI5167610002Medicare NSC
MIU92440Medicare UPIN
MI900B811100OtherBCBS
MIP00169100Medicare PIN
MI0N89570001Medicare PIN