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Individual

STEPHANIE MARIE BAXTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
230 E DAY RD, STE 100, MISHAWAKA, IN 46545-3408
(574) 271-3939
(574) 271-3941
Mailing address
230 E DAY RD, STE 100, MISHAWAKA, IN 46545-3408
(574) 271-3939
(574) 271-3941

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003890A
IN
152W00000X
Optometrist
5793
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201293730
IN
01
204460005
MEDICARE PTAN
IN
05
2856128
OH
Enumeration date
06/09/2008
Last updated
08/17/2015
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