Organization
R WAYNE BAKER OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. R WAYNE BAKER OD (OPTOMETRIST OWNER)
(770) 922-4900
Entity
Organization
Contact information
Practice address
1455AOLD MC DONOUGH RD, CONYERS, GA 30094-5979
(770) 922-4900
(770) 922-1563
Mailing address
1455A OLD MC DONOUGH RD, CONYERS, GA 30094-5979
(770) 922-4900
(770) 922-1563
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
000746T
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00003242C
—
GA
01
—
11584
AVESIS
GA
01
—
1830205
PMCS
GA
01
—
4268778
AETNA
GA
01
—
612585
ANTHEM BCBS
GA
01
—
GA3468
EYEMED
GA
Enumeration date
06/16/2008
Last updated
01/12/2009
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