Healthcare Provider Details

I. General information

NPI: 1710974183
Provider Name (Legal Business Name): MARK ROBERT BARLOW OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7331 WATSON RD
SAINT LOUIS MO
63119-4405
US

IV. Provider business mailing address

PO BOX 736480
CHICAGO IL
60673-1407
US

V. Phone/Fax

Practice location:
  • Phone: 314-633-8575
  • Fax: 314-362-3725
Mailing address:
  • Phone: 314-633-8575
  • Fax: 314-743-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2013007905
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: