Provider Demographics
NPI:1639128093
Name:BAKER, ROBERT LEONARD (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEONARD
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:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0746
Mailing Address - Country:US
Mailing Address - Phone:906-774-6288
Mailing Address - Fax:906-774-6295
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:906-774-6288
Practice Address - Fax:906-774-6295
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5029656Medicaid
MIT32714Medicare UPIN
MI0445460001Medicare NSC
MI5029656Medicaid