Provider Demographics
NPI:1841416062
Name:BARRETT, MICHAEL R (BCO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:BARRETT
Suffix:
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 COMMERCE VALLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7075
Mailing Address - Country:US
Mailing Address - Phone:715-833-2277
Mailing Address - Fax:715-833-2295
Practice Address - Street 1:4606 COMMERCE VALLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7075
Practice Address - Country:US
Practice Address - Phone:715-833-2277
Practice Address - Fax:715-833-2295
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1841416062Medicaid
WI38430000Medicaid
0437820008Medicare NSC
0437820005Medicare NSC
WI1841416062Medicaid