Provider Demographics
NPI:1639210347
Name:BAKER, MERLE CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:MERLE
Middle Name:CRAIG
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 57
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-0057
Mailing Address - Country:US
Mailing Address - Phone:712-362-3560
Mailing Address - Fax:712-362-3155
Practice Address - Street 1:121 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-2138
Practice Address - Country:US
Practice Address - Phone:712-362-3560
Practice Address - Fax:712-362-3155
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1218164Medicaid
0343680003Medicare NSC
IAI7661Medicare PIN
IA1218164Medicaid
CE9834Medicare PIN