Shelly D. Baker, OD, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003805 Issued in MI

Legal business name

SHELLY D. BAKER, OD, PC

Practice address

1252 W Lakeshore Dr
Manistique, MI 49854-1364

Phone

(906) 341-3933

Fax

(906) 341-3944

NPI assigned

Jan 17, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shelly Diane Baker, ODNPI 1336256288

Title

Optometrist/Owner

Phone

(906) 341-3933

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shelly D Baker, OD

  • Optometrist
  • Manistique, MI
  • NPI 1336256288
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327017600000",
    "number": "1407032691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1252 W LAKESHORE DR",
            "city": "MANISTIQUE",
            "state": "MI",
            "postal_code": "498541364",
            "telephone_number": "906-341-3933",
            "fax_number": "906-341-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1252 W LAKESHORE DR",
            "city": "MANISTIQUE",
            "state": "MI",
            "postal_code": "498541364",
            "telephone_number": "906-341-3933",
            "fax_number": "906-341-3944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELLY D. BAKER, OD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-17",
        "last_updated": "2012-01-20",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "906-341-3933",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "9006765000",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4173092",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Manistique, MI
• Providers in Manistique, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.