Individual
ROGER D BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
601 E MATTHEWS AVE, JONESBORO, AR 72401-3145
(870) 935-6396
(870) 935-4063
Mailing address
601 E MATTHEWS AVE, JONESBORO, AR 72401-3145
(870) 935-6396
(870) 935-4063
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2279
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110423722
—
AR
01
—
312635501
MISSOURI MEDICAID
MO
01
—
410009356
RAILROAD MEDICARE
AR
01
—
492367933
MEDICARE ID-TYPE UNSPECIFIED
AR
Enumeration date
07/28/2006
Last updated
04/29/2008
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