MEDICARE: DR. DALE IRVIN BARR OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT9931TPL	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0681170001	OTHER	CA	MEDICARE CIGNA DMERC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396749123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE IRVIN BARR OD

Provider Business Mailing Address
First Line	:	3273 WALTON WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95117-3074
Country	:	US
Telephone Number	:	408-249-8464
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 UNION AVE
Second Line	:	STE A
City	:	SAN JOSE
State	:	CA
Zip	:	95124-1431
Country	:	US
Telephone Number	:	408-371-2282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/30/2009

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