Provider Demographics
NPI:1700843307
Name:BARON, SAMUEL J
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:BARON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 FORD ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2427
Mailing Address - Country:US
Mailing Address - Phone:303-278-2020
Mailing Address - Fax:303-279-7623
Practice Address - Street 1:2301 FORD ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2427
Practice Address - Country:US
Practice Address - Phone:303-278-2020
Practice Address - Fax:303-279-7623
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO828152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08008286Medicaid
CO08008286Medicaid
COCO300928Medicare PIN
COT60883Medicare UPIN