Healthcare Provider Details

I. General information

NPI: 1730307984
Provider Name (Legal Business Name): TIMOTHY J BARRETT B.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7582 CURRELL BLVD SUITE 109
WOODBURY MN
55125-2262
US

IV. Provider business mailing address

800 WISCONSIN ST. MAILBOX 103 BUILDING D02 SUITE 315
EAU CLAIRE WI
54703-3613
US

V. Phone/Fax

Practice location:
  • Phone: 651-739-4111
  • Fax: 715-831-9090
Mailing address:
  • Phone: 715-831-9000
  • Fax: 715-831-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: