Provider Demographics
NPI:1164623229
Name:BARNARD, PAUL ROBERT (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:BARNARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 ASPEN HILLS CT
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-4785
Mailing Address - Country:US
Mailing Address - Phone:307-789-9742
Mailing Address - Fax:307-789-0077
Practice Address - Street 1:916 MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3441
Practice Address - Country:US
Practice Address - Phone:307-789-1500
Practice Address - Fax:307-789-0077
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY 105T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY305429Medicare ID - Type Unspecified