Provider Demographics
NPI:1982621801
Name:BAAS, ERIC A (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:BAAS
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 1:1306 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-5022
Mailing Address - Country:US
Mailing Address - Phone:312-949-7186
Mailing Address - Fax:
Practice Address - Street 1:3241 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3849
Practice Address - Country:US
Practice Address - Phone:312-949-7186
Practice Address - Fax:312-949-7660
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009895Medicaid
IL207909Medicare PIN
IL046009895Medicaid
ILIL2040001Medicare PIN
ILK28711Medicare PIN
V09550Medicare UPIN