Healthcare Provider Details

I. General information

NPI: 1477592145
Provider Name (Legal Business Name): ALLAN LESLIE MEYER BARKER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RIDGE LANE N.
WRIGHTSVILLE BEACH NC
28480
US

IV. Provider business mailing address

9 RIDGE LANE N.
WRIGHTSVILLE BEACH NC
28480
US

V. Phone/Fax

Practice location:
  • Phone: 252-904-1184
  • Fax: 252-451-5330
Mailing address:
  • Phone: 252-904-1184
  • Fax: 252-451-5330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0943
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: