Provider Demographics
NPI:1851497127
Name:BARRON, CAROL (OD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BARRON
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 1:360 S WAUKEGAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5654
Mailing Address - Country:US
Mailing Address - Phone:847-412-0311
Mailing Address - Fax:847-412-0316
Practice Address - Street 1:360 S WAUKEGAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5654
Practice Address - Country:US
Practice Address - Phone:847-412-0311
Practice Address - Fax:847-412-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL047017456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL87245Medicare ID - Type Unspecified