Provider Demographics
NPI:1659492262
Name:RALPH S BAKER,O.D.INC.
Entity Type:Organization
Organization Name:RALPH S BAKER,O.D.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-783-8131
Mailing Address - Street 1:531 OAK ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2615
Mailing Address - Country:US
Mailing Address - Phone:916-783-8131
Mailing Address - Fax:916-783-3465
Practice Address - Street 1:531 OAK ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2615
Practice Address - Country:US
Practice Address - Phone:916-783-8131
Practice Address - Fax:916-783-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0086620Medicaid
CAZZZ00080ZMedicare PIN
CA5349770001Medicare NSC
CAP00195202Medicare PIN