Healthcare Provider Details

I. General information

NPI: 1124044185
Provider Name (Legal Business Name): DOUGLAS C BARTON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22833 BOTHELL EVERETT HWY STE. 154
BOTHELL WA
98021-9372
US

IV. Provider business mailing address

22833 BOTHELL EVERETT HWY #154
BOTHELL WA
98021-9372
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-0430
  • Fax:
Mailing address:
  • Phone: 425-485-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1413
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: