Healthcare Provider Details

I. General information

NPI: 1265546469
Provider Name (Legal Business Name): JOHN L BARRINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 SW HAYTER ST
DALLAS OR
97338-1843
US

IV. Provider business mailing address

606 SW HAYTER ST
DALLAS OR
97338-1843
US

V. Phone/Fax

Practice location:
  • Phone: 503-949-5760
  • Fax:
Mailing address:
  • Phone: 503-949-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00001949
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2061ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: