Provider Demographics
NPI:1356341275
Name:BAER, ED CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:ED
Middle Name:CHARLES
Last Name:BAER
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 1:2117 NW FILLMORE AVE
Mailing Address - Street 2:CORVALLIS EYE CARE
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5624
Mailing Address - Country:US
Mailing Address - Phone:541-752-9606
Mailing Address - Fax:541-758-7201
Practice Address - Street 1:2117 NW FILLMORE AVE
Practice Address - Street 2:CORVALLIS EYE CARE
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5624
Practice Address - Country:US
Practice Address - Phone:541-752-9606
Practice Address - Fax:541-758-7201
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1197T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR930639687Medicare UPIN
OR0711200001Medicare NSC