Provider Demographics
NPI:1487650263
Name:BARRY, PATRICK J (OD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:BARRY
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 1:525 W WETMORE RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-5094
Mailing Address - Country:US
Mailing Address - Phone:520-293-2363
Mailing Address - Fax:520-293-0475
Practice Address - Street 1:525 W WETMORE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5094
Practice Address - Country:US
Practice Address - Phone:520-293-2363
Practice Address - Fax:520-293-0475
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ013AZ152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78760Medicare PIN
AZU17726Medicare UPIN