Provider Demographics
NPI:1013063676
Name:BAKER VISION CLINIC, INC.
Entity Type:Organization
Organization Name:BAKER VISION CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-523-5858
Mailing Address - Street 1:2150 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-2609
Mailing Address - Country:US
Mailing Address - Phone:541-523-5858
Mailing Address - Fax:541-523-7652
Practice Address - Street 1:2150 3RD ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2609
Practice Address - Country:US
Practice Address - Phone:541-523-5858
Practice Address - Fax:541-523-7652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1773ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150745Medicaid
OR150745Medicaid
OR0354930001Medicare NSC