Provider Demographics
NPI:1992867220
Name:BAISDEN, JOEL D (OD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
Last Name:BAISDEN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2505 N MAYFAIR RD
Practice Address - Street 2:#100
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1404
Practice Address - Country:US
Practice Address - Phone:414-453-7020
Practice Address - Fax:414-453-9980
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2283152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4687710001OtherDME
WI4687710001OtherDME
WIU36977Medicare UPIN
WIMB0610736OtherDEA