Provider Demographics
NPI:1568407377
Name:WOLSTAN, BARRY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JAMES
Last Name:WOLSTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23600 TELO AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4035
Mailing Address - Country:US
Mailing Address - Phone:310-543-2611
Mailing Address - Fax:310-543-2056
Practice Address - Street 1:23600 TELO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4035
Practice Address - Country:US
Practice Address - Phone:310-543-2611
Practice Address - Fax:310-543-2056
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30536207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44456Medicare UPIN
CA0896110001Medicare NSC
CAG30536AMedicare PIN
CACX746ZMedicare PIN