Michael L. Baird, O.D.
Individual provider Active NPI Optometrist · Chubbuck, ID
NPI 1457524555 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1457524555
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- ODP967 (ID)
- Practice address
- 4240 Yellowstone Ave
Chubbuck, ID 83202-2420 - Phone
- (208) 238-2020
- Fax
- (208) 230-2069
- NPI assigned
- Apr 9, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ODP967 | ID | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael Baird Optometry PC | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ODP967 | ID | Yes |
Addresses
Primary practice location
4240 Yellowstone Ave
Chubbuck, ID 83202-2420
Mailing address
966 Old Glory Way
Chubbuck, ID 83202-1779
Phone (208) 709-0540
Other providers in Chubbuck, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.