Basic Information
| Provider Information | |||||||||
| NPI: | 1184770281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALTHASER | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 MACOMB | ||||||||
| Address2: | |||||||||
| City: | MT CLEMENS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864687370 | ||||||||
| FaxNumber: | 5864641472 | ||||||||
| Practice Location | |||||||||
| Address1: | 4920 MILAN RD | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196240456 | ||||||||
| FaxNumber: | 4196249215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5370T2281 | OH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.