Provider Demographics
NPI:1831126697
Name:BAXTER, BRIAN D (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:BAXTER
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 1:3501 MEMORIAL PKWY SW
Mailing Address - Street 2:STE 200
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5358
Mailing Address - Country:US
Mailing Address - Phone:256-533-0315
Mailing Address - Fax:256-536-0360
Practice Address - Street 1:3501 MEMORIAL PKWY SW
Practice Address - Street 2:STE 200
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5358
Practice Address - Country:US
Practice Address - Phone:256-533-0315
Practice Address - Fax:256-536-0360
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR151TA719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1831126697Medicaid
AL515-93468OtherBLUE CROSS BLUESHIELD
AL051557540Medicaid
ALP00334247OtherRR MEDICARE
ALP00334247OtherRR MEDICARE
AL051557540Medicaid
AL051557540Medicare PIN