Provider Demographics
NPI:1861659856
Name:KEITH D. BARKER OD PC
Entity Type:Organization
Organization Name:KEITH D. BARKER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD PC
Authorized Official - Phone:505-769-2339
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-0609
Mailing Address - Country:US
Mailing Address - Phone:575-769-2339
Mailing Address - Fax:
Practice Address - Street 1:621 E LLANO ESTACADO BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3758
Practice Address - Country:US
Practice Address - Phone:575-769-2339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2239T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMA100493Medicare PIN
NM0771450001Medicare NSC