Individual
DR. SHELLY D BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1252 W LAKESHORE DR, MANISTIQUE, MI 49854-1364
(906) 341-3933
(906) 341-3944
Mailing address
1252 W LAKESHORE DR, MANISTIQUE, MI 49854-1364
(906) 341-3933
(906) 341-3944
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003805
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4152181
—
MI
05
—
4173092
—
MI
01
—
9006765000
BCBS
MI
01
—
900A760100
BLUE CROSS & BLUE SHIELD
—
Enumeration date
08/24/2006
Last updated
08/14/2020
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