Provider Demographics
NPI:1629694310
Name:BARBIERO, ANNA FULLER (OD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:FULLER
Last Name:BARBIERO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:KATHRYN
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:116 KILLGORE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-7090
Mailing Address - Country:US
Mailing Address - Phone:318-251-3626
Mailing Address - Fax:
Practice Address - Street 1:116 KILLGORE RD STE 1
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-7090
Practice Address - Country:US
Practice Address - Phone:318-251-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1920-856AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist