Basic Information
Provider Information
NPI: 1073644134
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAER
FirstName: WILLIAM
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 EAST JEFFERSON STREET
Address2: KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
City: ROCKVILLE
State: MD
PostalCode: 20852
CountryCode: US
TelephoneNumber: 3018166660
FaxNumber: 3018166308
Practice Location
Address1: 201 NORTH WASHINGTON STREET
Address2:  
City: FALLS CHURCH
State: VA
PostalCode: 22046
CountryCode: US
TelephoneNumber: 7032374000
FaxNumber: 7035361400
Other Information
ProviderEnumerationDate: 03/08/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X0618000462VAY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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