Individual
BRADLEY R BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
516 JAY ST, COLUSA, CA 95932-2436
(530) 458-2020
(530) 458-8977
Mailing address
516 JAY ST, COLUSA, CA 95932-2436
(530) 458-2020
(530) 458-8977
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7125T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GSD004280
MEDICAL GRP #
CA
05
—
SD0071250
—
CA
01
—
ZZZ07805Z
BS GROUP
CA
Enumeration date
05/24/2006
Last updated
05/13/2013
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