MEDICARE: BARKER FAMILY VISION CARE LLC

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	TO3261	MO

General Provider Information

NPI Number	:	1770771461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARKER FAMILY VISION CARE LLC

Provider Business Mailing Address
First Line	:	241 BOS CIR
Second Line	:
City	:	SPOKANE
State	:	MO
Zip	:	65754-9100
Country	:	US
Telephone Number	:	417-587-0221
Fax Number	:

Provider Business Practice Location Address
First Line	:	18401 STATE HIGHWAY 13
Second Line	:
City	:	BRANSON WEST
State	:	MO
Zip	:	65737-9609
Country	:	US
Telephone Number	:	417-272-0169
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL RAY BARKER
Credential	:	O.D.
Telephone Number	:	417-587-0221

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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