Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist | SL1875 | CA |
N | 156FC0800X | Contact Lens | CL325 | CA |
NPI | 1093847733 |
---|---|
Provider Name | Mr. Gary Ronald Baker |
First Address | Modesto, CA 95350-4042 |
Second Address | Modesto, CA 95350-4042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 20/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
#207 | HEARING AID DISPENSER (01) | CA |
CL325 | REGISTERED CONTACT LENS DISPENSER (01) | CA |
SL1875 | REGISTERED SPECTACLE LENS DISPENSER (01) | CA |
ZZZ71978Z | (05) | CA |