Healthcare Provider Details

I. General information

NPI: 1558525691
Provider Name (Legal Business Name): DAVID SHANE BARKER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MEDICAL PLAZA LN
WHITESBURG KY
41858
US

IV. Provider business mailing address

PO BOX 40
WHITESBURG KY
41858-0040
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-4871
  • Fax:
Mailing address:
  • Phone: 606-633-4823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1733DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: