Provider Demographics
NPI:1174591291
Name:BAKER, THOMAS L (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
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:PO BOX 50720
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0720
Mailing Address - Country:US
Mailing Address - Phone:806-467-0459
Mailing Address - Fax:806-355-1284
Practice Address - Street 1:1916 N HOBART ST
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-3413
Practice Address - Country:US
Practice Address - Phone:806-669-2824
Practice Address - Fax:806-355-1284
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01951TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80646QOtherBCBS
TX117346004Medicaid
TX80646QOtherBCBS
TX117346004Medicaid