Provider Demographics
NPI:1700840782
Name:FABRIZIANI, BARRY R (OD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:R
Last Name:FABRIZIANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 GRIFFEN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4448
Mailing Address - Country:US
Mailing Address - Phone:610-933-1144
Mailing Address - Fax:610-933-7067
Practice Address - Street 1:286 GRIFFEN ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4448
Practice Address - Country:US
Practice Address - Phone:610-933-1144
Practice Address - Fax:610-933-7067
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA730956Medicare PIN