Healthcare Provider Details

I. General information

NPI: 1366442220
Provider Name (Legal Business Name): BARBARA MARCUSSEN VAHER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA L MARCUSSEN OD

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SPRUCE ST
BELMONT NC
28012-3370
US

IV. Provider business mailing address

1200 SPRUCE ST
BELMONT NC
28012-3370
US

V. Phone/Fax

Practice location:
  • Phone: 704-825-9002
  • Fax: 704-825-5440
Mailing address:
  • Phone: 704-825-9002
  • Fax: 704-825-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1444
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: