Provider Demographics
NPI:1730307984
Name:BARRETT, TIMOTHY J (BCO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:BARRETT
Suffix:
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 WISCONSIN ST. MAILBOX 103
Mailing Address - Street 2:BUILDING D02 SUITE 315
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3613
Mailing Address - Country:US
Mailing Address - Phone:715-831-9000
Mailing Address - Fax:715-831-9090
Practice Address - Street 1:7582 CURRELL BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2262
Practice Address - Country:US
Practice Address - Phone:651-739-4111
Practice Address - Fax:715-831-9090
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38459900Medicaid