Provider Demographics
NPI:1487665360
Name:BARBER, MATTHEW G (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:BARBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:G
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05820TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148279602Medicaid
TX05820TGOtherOPTOMETRY LICENSE
TXU75460Medicare UPIN
TX8F5938Medicare PIN