1124099502 NPI number — DR. AMANDA LEIGH BARKER OD

Table of content: DR. AMANDA LEIGH BARKER OD (NPI 1124099502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124099502 NPI number — DR. AMANDA LEIGH BARKER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARKER
Provider First Name:
AMANDA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124099502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7547 WATERSIDE LOOP RD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28037-7677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-822-9920
Provider Business Mailing Address Fax Number:
704-822-1764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7547 WATERSIDE LOOP RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28037-7678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-822-9920
Provider Business Practice Location Address Fax Number:
704-822-1764
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  NC 1851 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2120531 . This is a "MAMSI LIFE AND HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: C8178 . This is a "MEDCOST INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2472315A . This is a "MEDICARE COMPLETE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 093K3 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: NC1851 . This is a "EYEMED VISION CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 802245 . This is a "COMMUNITY EYE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2472315A . This is a "MEDICARE CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89093K3 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89093K3 . This is a "DMA PROVIDER SERVICES" identifier . This identifiers is of the category "OTHER".




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