Provider Demographics
NPI:1891120564
Name:BARRY, MICHAEL DENNIS (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DENNIS
Last Name:BARRY
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:PO BOX 1910
Mailing Address - Street 2:171 YODER AVE
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-1910
Mailing Address - Country:US
Mailing Address - Phone:970-949-1320
Mailing Address - Fax:970-949-9438
Practice Address - Street 1:171 YODER AV.
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-1910
Practice Address - Country:US
Practice Address - Phone:970-949-1320
Practice Address - Fax:970-949-9438
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist