Provider Demographics
NPI:1174664486
Name:BARRETO, THOMAS M (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:BARRETO
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 1:2300 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1611
Mailing Address - Country:US
Mailing Address - Phone:503-284-2300
Mailing Address - Fax:503-284-2347
Practice Address - Street 1:2300 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1611
Practice Address - Country:US
Practice Address - Phone:503-284-2300
Practice Address - Fax:503-284-2347
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1809ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67410Medicare UPIN