Provider Demographics
NPI:1679550826
Name:BARKLUND, J R (OD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:R
Last Name:BARKLUND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:RICARD
Other - Last Name:BARKLUND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:15189 MONTANUS DR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-1679
Practice Address - Country:US
Practice Address - Phone:540-825-8220
Practice Address - Fax:540-825-8675
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9235329Medicaid
T90609Medicare UPIN
VA9235329Medicaid