Provider Demographics
NPI:1174630677
Name:ALLAN BAKER INC
Entity type:Organization
Organization Name:ALLAN BAKER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:502-897-1656
Mailing Address - Street 1:3801 BISHOP LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2905
Mailing Address - Country:US
Mailing Address - Phone:502-895-2020
Mailing Address - Fax:502-657-4979
Practice Address - Street 1:4036 DUTCHMANS LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4704
Practice Address - Country:US
Practice Address - Phone:502-895-2020
Practice Address - Fax:502-657-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY27156FX1100X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
16739OtherDUPONT SPECTERA
16740OtherDIXIE SPECTERA
40676OtherDAVIS VISION
9120628792OtherDUPONT PASSPORT BLOCK
K1411506OtherDIXIE CLARITY VISION
14602OtherCVILLE SPECTERA
KY52900271Medicaid
KY0027OtherDUPONT EYE MED
22285OtherPIN # AVESIS
K1411522OtherCVILLE CLARITY VISION
K0247795OtherDUPONT CLARITY VISION
000000210920OtherCVILLE
000000213527OtherDUPONT ANTHEM BCBS
000000213814OtherDIXIE
00648OtherVEN # AVESIS
40676OtherDAVIS VISION
000000210920OtherCVILLE
K1411506OtherDIXIE CLARITY VISION
U91753Medicare UPIN
40676OtherDAVIS VISION