Healthcare Provider Details

I. General information

NPI: 1841395613
Provider Name (Legal Business Name): DAVID L BARRETT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 MONTGOMERY NE SUITE 110
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

4253 MONTGOMERY NE SUITE 110
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-3744
  • Fax: 505-881-8931
Mailing address:
  • Phone: 505-881-3744
  • Fax: 505-881-8931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP2314
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT7732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: