Provider Demographics
NPI:1245391457
Name:BARNARD, AMOS GARY (OD)
Entity Type:Individual
Prefix:DR
First Name:AMOS
Middle Name:GARY
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 1:186 N LYMAN ST
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1813
Mailing Address - Country:US
Mailing Address - Phone:330-334-1076
Mailing Address - Fax:330-336-3403
Practice Address - Street 1:186 N LYMAN ST
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1813
Practice Address - Country:US
Practice Address - Phone:330-334-1076
Practice Address - Fax:330-336-3403
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT46132Medicare UPIN