Provider Demographics
NPI:1679686810
Name:BARAK, TAL ASHER (OD)
Entity Type:Individual
Prefix:DR
First Name:TAL
Middle Name:ASHER
Last Name:BARAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:202 COSTCO DR
Mailing Address - Street 2:OPTICAL DEPARTMENT
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-4858
Mailing Address - Country:US
Mailing Address - Phone:626-318-6930
Mailing Address - Fax:412-490-2226
Practice Address - Street 1:202 COSTCO DR
Practice Address - Street 2:OPTICAL DEPARTMENT
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-4858
Practice Address - Country:US
Practice Address - Phone:626-318-6930
Practice Address - Fax:412-490-2226
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11603T152W00000X
PAOEG002553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99341Medicare UPIN