Organization
SHELLY D. BAKER, OD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELLY DIANE BAKER OD (OPTOMETRIST/OWNER)
(906) 341-3933
Entity
Organization
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
—
4173092
—
MI
01
—
9006765000
BCBS OF MI
MI
Enumeration date
01/17/2008
Last updated
01/20/2012
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