Provider Demographics
NPI:1558443887
Name:MASIELLO, BARBARA (OD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:MASIELLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12609 VICTORY LAKES LOOP
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-1274
Mailing Address - Country:US
Mailing Address - Phone:571-268-3329
Mailing Address - Fax:
Practice Address - Street 1:528 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3011
Practice Address - Country:US
Practice Address - Phone:540-347-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618-001456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA184889OtherANTHEM BCBS/HEALTHKEEPERS
VA184884OtherANTHEM BCBS/HEALTHKEEPERS
VA184881OtherANTHEM BCBS/HEALTHKEEPERS
VA184886OtherANTHEM BCBS/HEALTHKEEPERS
VA184884OtherANTHEM BCBS/HEALTHKEEPERS
VA184889OtherANTHEM BCBS/HEALTHKEEPERS
VA010206987Medicaid
VA184881OtherANTHEM BCBS/HEALTHKEEPERS
VA008759N82Medicare ID - Type UnspecifiedTRAILBLAZERS CENTAL VA
VA010206995Medicaid
VA184886OtherANTHEM BCBS/HEALTHKEEPERS