Provider Demographics
NPI:1689669749
Name:PORTER, BARBARA R (OD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:R
Last Name:PORTER
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 1:656 S GEARY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1220
Mailing Address - Country:US
Mailing Address - Phone:724-542-8009
Mailing Address - Fax:
Practice Address - Street 1:11 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-1714
Practice Address - Country:US
Practice Address - Phone:724-887-5820
Practice Address - Fax:724-887-5825
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001825447Medicaid
PA042842RSXMedicare ID - Type Unspecified
PA001825447Medicaid