Provider Demographics
NPI:1104037456
Name:VILLA, BARBARA JEAN (OD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:VILLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28331 LA PLUMOSA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7050
Mailing Address - Country:US
Mailing Address - Phone:949-400-1530
Mailing Address - Fax:
Practice Address - Street 1:2700 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782
Practice Address - Country:US
Practice Address - Phone:714-259-1530
Practice Address - Fax:714-259-1532
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10245 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist