Provider Demographics
NPI:1235116468
Name:BARKER, GARY LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:BARKER
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 1:1928 HOWELL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1013
Mailing Address - Country:US
Mailing Address - Phone:407-671-5445
Mailing Address - Fax:407-671-2899
Practice Address - Street 1:1928 HOWELL BRANCH RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1013
Practice Address - Country:US
Practice Address - Phone:407-671-5445
Practice Address - Fax:407-671-2899
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1813152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084702000Medicaid
FLT84187Medicare UPIN
FL084702000Medicaid