Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1259 | KY |
NPI | 1124365739 |
---|---|
Provider Name | Steven Baker |
First Address | Louisville, KY 40218-2905 |
Second Address | Louisville, KY 40207-4704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2013 |
Last Update Date | 16/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
52900271 | (05) | KY |
U91753 | (02) | KY |