Provider Demographics
NPI:1649246158
Name:BARR, JANICE A (OD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:BARR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5366 ESTATE OFFICE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0611
Mailing Address - Country:US
Mailing Address - Phone:901-683-9183
Mailing Address - Fax:901-683-9186
Practice Address - Street 1:5366 ESTATE OFFICE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0611
Practice Address - Country:US
Practice Address - Phone:901-683-9183
Practice Address - Fax:901-683-9186
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4139393OtherBLUE CROSS BLUE CROSS
T61278Medicare UPIN
TN3595992Medicare PIN
TN4616620001Medicare NSC