Provider Demographics
NPI:1982888996
Name:BAKER EYE INSTITUTE
Entity Type:Organization
Organization Name:BAKER EYE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN CLINIC MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LITTLETON
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:501-329-3937
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-1490
Mailing Address - Country:US
Mailing Address - Phone:501-932-0118
Mailing Address - Fax:501-932-0070
Practice Address - Street 1:810 MERRIMAN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AZ
Practice Address - Zip Code:72032-4436
Practice Address - Country:US
Practice Address - Phone:501-932-0118
Practice Address - Fax:501-932-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
5C112Medicare PIN