Healthcare Provider Details

I. General information

NPI: 1124099502
Provider Name (Legal Business Name): AMANDA LEIGH BARKER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7547 WATERSIDE LOOP RD STE A
DENVER NC
28037-7678
US

IV. Provider business mailing address

7547 WATERSIDE LOOP RD STE A
DENVER NC
28037-7677
US

V. Phone/Fax

Practice location:
  • Phone: 704-822-9920
  • Fax: 704-822-1764
Mailing address:
  • Phone: 704-822-9920
  • Fax: 704-822-1764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNC 1851
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: