Provider Demographics
NPI:1861430043
Name:BAKER, RALPH SIMON (OD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:SIMON
Last Name:BAKER
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 1:9221 SIERRA COLLEGE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5919
Mailing Address - Country:US
Mailing Address - Phone:916-797-6747
Mailing Address - Fax:916-797-6728
Practice Address - Street 1:9221 SIERRA COLLEGE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5919
Practice Address - Country:US
Practice Address - Phone:916-797-6747
Practice Address - Fax:916-797-6728
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8662T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0086620Medicaid
CASD0086622Medicare PIN
CAU43572Medicare UPIN