Provider Demographics
NPI:1861490443
Name:BARSH, LARRY ZANE (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ZANE
Last Name:BARSH
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1414
Mailing Address - Country:US
Mailing Address - Phone:304-891-2202
Mailing Address - Fax:
Practice Address - Street 1:151 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1414
Practice Address - Country:US
Practice Address - Phone:304-927-1940
Practice Address - Fax:304-927-0009
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-05-15
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
FL1326156FX1800X
237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0151775000Medicaid