Provider Demographics
NPI:1710974183
Name:BARLOW, MARK ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:BARLOW
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 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8096
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-3937
Mailing Address - Fax:314-362-3725
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:6TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-362-3937
Practice Address - Fax:314-362-3725
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013007905152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO310075018Medicaid
IL180035689OtherMEDICARE RAILROAD
051448OtherHEALTH ALLIANCE
802258OtherEYEMED
IL0814870009OtherMEDICARE NSC NUMBER
IL0814870024OtherMEDICARE NSC NUMBER
IL0814870010OtherMEDICARE NSC NUMBER
IL0814870023OtherMEDICARE NSC NUMBER
802258OtherEYEMED
U57608Medicare UPIN
IL180035689OtherMEDICARE RAILROAD
IL0814870010OtherMEDICARE NSC NUMBER