Provider Demographics
NPI:1326029406
Name:BARTON, JR., ROBERT M (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:BARTON, JR.
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 1:1540A WILDCAT DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2814
Mailing Address - Country:US
Mailing Address - Phone:361-643-1516
Mailing Address - Fax:361-643-7479
Practice Address - Street 1:1540A WILDCAT DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2814
Practice Address - Country:US
Practice Address - Phone:361-643-1516
Practice Address - Fax:361-643-7479
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2279TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093312902Medicaid
TX093312902Medicaid
TX0925580001Medicare NSC
TX00E57CMedicare PIN