Basic Information
Provider Information
NPI: 1356571962
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARBER
FirstName: ANGELA
MiddleName: MARIE
NamePrefix: DR.
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2216 LINCOLN WAY E
Address2:  
City: MASSILLON
State: OH
PostalCode: 446467062
CountryCode: US
TelephoneNumber: 3308329966
FaxNumber:  
Practice Location
Address1: 2216 LINCOLN WAY EAST
Address2:  
City: MASSILLON
State: OH
PostalCode: 44646
CountryCode: US
TelephoneNumber: 3308329966
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/16/2009
LastUpdateDate: 07/16/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X5841T2755OHY Eye and Vision Services ProvidersOptometrist 

No ID Information.


Home