Individual
ROBERT RAY BALTIERRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8089 MAIN ST STE 1, DEXTER, MI 48130-1079
(734) 424-9230
(734) 424-2576
Mailing address
8089 MAIN ST, DEXTER, MI 48130-1079
(734) 424-9230
(734) 424-2576
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005154
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C97655
BCBS
MI
Enumeration date
04/27/2017
Last updated
04/14/2025
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