Provider Demographics
NPI:1710146493
Name:BRONTE D BAKER OD INC
Entity Type:Organization
Organization Name:BRONTE D BAKER OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRONTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-358-3218
Mailing Address - Street 1:1209 N ST MARYS STREET
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102
Mailing Address - Country:US
Mailing Address - Phone:361-358-3218
Mailing Address - Fax:361-358-3281
Practice Address - Street 1:1209 N ST MARYS STREET
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102
Practice Address - Country:US
Practice Address - Phone:361-358-3218
Practice Address - Fax:361-358-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2224TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093501701Medicaid
TX00E98AOtherBLUE CROSS BLUE SHIELD OF TEXAS
410011275OtherRAILROAD MEDICARE
410011275OtherRAILROAD MEDICARE
TX0202890001Medicare NSC
TXT12043Medicare UPIN