Provider Demographics
NPI:1619441482
Name:ASHLEY BAKER OD LLC
Entity Type:Organization
Organization Name:ASHLEY BAKER OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-324-5206
Mailing Address - Street 1:236 OLD COUNTRY RD S
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4828
Mailing Address - Country:US
Mailing Address - Phone:561-324-5206
Mailing Address - Fax:
Practice Address - Street 1:6045 HAGEN RANCH RD STE 5
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7251
Practice Address - Country:US
Practice Address - Phone:561-324-5206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier