Provider Demographics
NPI:1992854012
Name:BAKER CONNOR, CAROLYN JOY (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:JOY
Last Name:BAKER CONNOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:JOY
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:419 VINEYARD TOWN CENTER
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037
Mailing Address - Country:US
Mailing Address - Phone:408-779-2266
Mailing Address - Fax:408-779-5051
Practice Address - Street 1:419 VINEYARD TOWN CENTER
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037
Practice Address - Country:US
Practice Address - Phone:408-779-2266
Practice Address - Fax:408-779-5051
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10472T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
EH661ZMedicare PIN