Provider Demographics
NPI:1518399781
Name:BARBUSH, GREG MITCHELL (OD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:MITCHELL
Last Name:BARBUSH
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 1:8109 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-9205
Mailing Address - Country:US
Mailing Address - Phone:410-665-1779
Mailing Address - Fax:410-668-0614
Practice Address - Street 1:4313 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2143
Practice Address - Country:US
Practice Address - Phone:410-529-1950
Practice Address - Fax:410-529-9073
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2361152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist