Provider Demographics
NPI:1003592692
Name:STIVALA, BARBARA ELLEN HYLER (OD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ELLEN HYLER
Last Name:STIVALA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ELLEN
Other - Last Name:HYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4821
Mailing Address - Country:US
Mailing Address - Phone:713-743-1921
Mailing Address - Fax:713-743-0963
Practice Address - Street 1:655 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4821
Practice Address - Country:US
Practice Address - Phone:817-289-6800
Practice Address - Fax:817-289-6825
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10852OtherOPTOMETRY LICENSE