Basic Information
| Provider Information | |||||||||
| NPI: | 1063409597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DELBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 STORY ST | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500362834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154322020 | ||||||||
| FaxNumber: | 5154328482 | ||||||||
| Practice Location | |||||||||
| Address1: | 718 STORY ST | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500362834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154322020 | ||||||||
| FaxNumber: | 5154328482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 01812 | IA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 1015313 | 05 | IA | MEDICAID |