Individual
R. WAYNE BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1455A OLD MCDONOUGH RD.SE, CONYERS, GA 30094-5979
(770) 922-4900
(770) 922-1563
Mailing address
1455 OLD MCDONOUGH HWY SE STE A, 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
08/31/2006
Last updated
12/30/2014
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