Provider Demographics
NPI:1235105677
Name:BASDEN, BARRY RAYFORD (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:RAYFORD
Last Name:BASDEN
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 1:711 COX CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1001
Mailing Address - Country:US
Mailing Address - Phone:256-766-3139
Mailing Address - Fax:256-767-7374
Practice Address - Street 1:711 COX CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1001
Practice Address - Country:US
Practice Address - Phone:256-766-3139
Practice Address - Fax:256-767-7374
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-722-TA-009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51058371OtherBCBS OF ALABAMA
AL0663380001OtherPALMETTO GBA/DMERC
AL51517600OtherBCBS OF AL: 2ND LOCATION
AL000058371BASMedicaid
AL009933175Medicaid
AL0663380001Medicare NSC
AL000058371BASMedicaid
AL000058371BASMedicare ID - Type UnspecifiedALABAMA MEDICARE NUMBER