Provider Demographics
NPI:1841395613
Name:BARRETT, DAVID L (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:BARRETT
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 1:4253 MONTGOMERY NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-881-3744
Mailing Address - Fax:505-881-8931
Practice Address - Street 1:4253 MONTGOMERY NE
Practice Address - Street 2:SUITE 110
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-881-3744
Practice Address - Fax:505-881-8931
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOP2314152W00000X
CAOPT7732152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA2439Medicaid
NMA2439Medicaid