Provider Demographics
NPI:1679577027
Name:BAKER, JOSHUA W (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:W
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 1:820 LOWER DALLAS HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034
Mailing Address - Country:US
Mailing Address - Phone:704-922-9808
Mailing Address - Fax:704-922-8213
Practice Address - Street 1:820 LOWER DALLAS HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034
Practice Address - Country:US
Practice Address - Phone:704-922-9808
Practice Address - Fax:704-922-8213
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1826152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093JKOtherBLUE CROSS OF NC
NC89093JKMedicaid
NCB9146OtherMEDCOST
NC802972OtherPARTNERS MEDICARE CHOICE
NC89093JKMedicaid
NC093JKOtherBLUE CROSS OF NC
NC802972OtherPARTNERS MEDICARE CHOICE