Provider Demographics
NPI:1497788434
Name:BARBER, MERLE I (OD)
Entity Type:Individual
Prefix:
First Name:MERLE
Middle Name:I
Last Name:BARBER
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 1:1300 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3902
Mailing Address - Country:US
Mailing Address - Phone:702-385-2242
Mailing Address - Fax:702-382-7955
Practice Address - Street 1:1300 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3902
Practice Address - Country:US
Practice Address - Phone:702-385-2242
Practice Address - Fax:702-382-7955
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV870004812OtherPALMETTO GBA RAILROAD MED
NV002502496Medicaid
NVV33243Medicare PIN
NVT67136Medicare UPIN
NV870004812OtherPALMETTO GBA RAILROAD MED