R Wayne Baker OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

000746T Issued in GA

Legal business name

R WAYNE BAKER OD PC

Practice address

1455Aold MC Donough Rd
Conyers, GA 30094-5979

Phone

(770) 922-4900

Fax

(770) 922-1563

NPI assigned

Jun 16, 2008

Organization subpart

No

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

Authorized official

Name

Dr. R Wayne Baker, OD

Title

Optometrist Owner

Phone

(770) 922-4900

Specialties & licenses 1

Addresses

Other identifiers 6

Locations

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231718400000",
    "number": "1457511149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455A OLD MC DONOUGH RD",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945979",
            "telephone_number": "770-922-4900",
            "fax_number": "770-922-1563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455AOLD MC DONOUGH RD",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945979",
            "telephone_number": "770-922-4900",
            "fax_number": "770-922-1563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R WAYNE BAKER OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2009-01-12",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OPTOMETRIST OWNER",
        "authorized_official_telephone_number": "770-922-4900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "000746T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PMCS",
            "identifier": "1830205",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "612585",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "GA3468",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00003242C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4268778",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "11584",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Conyers, GA
• Providers in Conyers, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.