Provider Demographics
NPI:1790356996
Name:BARR, KEILA (OD)
Entity Type:Individual
Prefix:DR
First Name:KEILA
Middle Name:
Last Name:BARR
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 1:32287 CORTE SAN VINCENTE
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6353
Mailing Address - Country:US
Mailing Address - Phone:956-545-5335
Mailing Address - Fax:
Practice Address - Street 1:41238 MARGARITA RD STE 105
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5552
Practice Address - Country:US
Practice Address - Phone:951-587-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10205152W00000X
CA35236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35236OtherCALIFORNIA OPTOMETRY BOARD