Provider Demographics
NPI:1497725642
Name:PASCO, BARRY A (OD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:PASCO
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 1:5891 W EUGIE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1252
Mailing Address - Country:US
Mailing Address - Phone:602-588-6600
Mailing Address - Fax:
Practice Address - Street 1:5891 W EUGIE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1252
Practice Address - Country:US
Practice Address - Phone:602-588-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00354152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035172Medicaid
AZT76804Medicare UPIN
AZ035172Medicaid
AZ68572Medicare ID - Type Unspecified
AZ60786Medicare ID - Type Unspecified
AZ60785Medicare ID - Type Unspecified
AZ75380Medicare ID - Type Unspecified
AZWCKHG05Medicare ID - Type Unspecified