Provider Demographics
NPI:1811560550
Name:BARR, AUSTIN DAVID (OD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DAVID
Last Name:BARR
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 1:41637 MARGARITA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-2990
Mailing Address - Country:US
Mailing Address - Phone:951-296-9300
Mailing Address - Fax:951-296-6398
Practice Address - Street 1:41637 MARGARITA RD STE 100
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-2990
Practice Address - Country:US
Practice Address - Phone:951-296-9300
Practice Address - Fax:951-296-6398
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35249152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35249OtherOPTOMETRY LICENSE