Provider Demographics
NPI:1902906027
Name:BAKER, TAD D (OD)
Entity Type:Individual
Prefix:DR
First Name:TAD
Middle Name:D
Last Name:BAKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1223 N ROCK RD
Mailing Address - Street 2:BLDG C
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1277
Mailing Address - Country:US
Mailing Address - Phone:316-634-2020
Mailing Address - Fax:316-634-2025
Practice Address - Street 1:1223 N ROCK RD
Practice Address - Street 2:BLDG C
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1277
Practice Address - Country:US
Practice Address - Phone:316-634-2020
Practice Address - Fax:316-634-2025
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1502-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS052542Medicare PIN
KS052548Medicare PIN
KS410036167Medicare PIN
KSU68110Medicare UPIN
KS0457860001Medicare PIN