Provider Demographics
NPI:1679561542
Name:BAKER, ANGIE PRUITT (OD)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:PRUITT
Last Name:BAKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 LITTLE KITTEN AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7578
Mailing Address - Country:US
Mailing Address - Phone:785-313-2796
Mailing Address - Fax:
Practice Address - Street 1:8072 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-7069
Practice Address - Country:US
Practice Address - Phone:785-240-5516
Practice Address - Fax:785-239-4065
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist