Provider Demographics
NPI:1598867020
Name:WASHBURN, BARBARA THERESA (OD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:THERESA
Last Name:WASHBURN
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 1:4330 CZECH LN NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2334
Mailing Address - Country:US
Mailing Address - Phone:319-378-6335
Mailing Address - Fax:319-378-9626
Practice Address - Street 1:4330 CZECH LN NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2334
Practice Address - Country:US
Practice Address - Phone:319-378-6335
Practice Address - Fax:319-378-9626
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0025155Medicaid
IAU11696Medicare UPIN
IA02515Medicare ID - Type Unspecified