Provider Demographics
NPI:1326059213
Name:MATTHEW G. BARBER, OD, PA
Entity Type:Organization
Organization Name:MATTHEW G. BARBER, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-343-6281
Mailing Address - Street 1:6224 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5525
Mailing Address - Country:US
Mailing Address - Phone:817-434-6281
Mailing Address - Fax:817-569-7736
Practice Address - Street 1:6224 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5525
Practice Address - Country:US
Practice Address - Phone:817-434-6281
Practice Address - Fax:817-569-7736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05820TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197153301Medicaid
TX197153301Medicaid
TXU75460Medicare UPIN