Active NPI
R. Wayne Baker, OD
- Optometrist
- Conyers, GA
National Provider Identifier
1669583563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 000746T
- Practice address
- 1455A Old McDonough Rd.SE
Conyers, GA 30094-5979 - Phone
- (770) 922-4900
- Fax
- (770) 922-1563
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 000746T | GA | Primary |
Addresses
Primary practice location
1455A Old McDonough Rd.SE
Conyers, GA 30094-5979
Mailing address
1455 Old McDonough Hwy SE Ste a
Conyers, GA 30094-5979
Phone (770) 922-4900
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4268778 | Other | GA | AETNA |
| 00003242C | Medicaid | GA | |
| 11584 | Other | GA | AVESIS |
| GA3468 | Other | GA | EYEMED |
| 1830205 | Other | GA | PMCS |
| 612585 | Other | GA | ANTHEM BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000746T | GA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419897600000",
"number": "1669583563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1455 OLD MCDONOUGH HWY SE STE A",
"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": "1455A OLD MCDONOUGH RD.SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300945979",
"telephone_number": "770-922-4900",
"fax_number": "770-922-1563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAKER",
"first_name": "R.",
"middle_name": "WAYNE",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2014-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "000746T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4268778",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00003242C",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVESIS",
"identifier": "11584",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYEMED",
"identifier": "GA3468",
"state": "GA"
},
{
"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"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.