Provider Demographics
NPI:1366442220
Name:VAHER, BARBARA MARCUSSEN (OD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:MARCUSSEN
Last Name:VAHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:L
Other - Last Name:MARCUSSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1200 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3370
Mailing Address - Country:US
Mailing Address - Phone:704-825-9002
Mailing Address - Fax:704-825-5440
Practice Address - Street 1:1200 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3370
Practice Address - Country:US
Practice Address - Phone:704-825-9002
Practice Address - Fax:704-825-5440
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909039Medicaid
NC09039OtherBCBS IND
NC8909039Medicaid
NCU34041Medicare UPIN