Provider Demographics
NPI:1902007446
Name:BARBARA VILLA OD PC
Entity Type:Organization
Organization Name:BARBARA VILLA OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-400-1530
Mailing Address - Street 1:28331 LA PLUMOSA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7050
Mailing Address - Country:US
Mailing Address - Phone:949-400-1530
Mailing Address - Fax:
Practice Address - Street 1:2700 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782
Practice Address - Country:US
Practice Address - Phone:714-259-1530
Practice Address - Fax:714-259-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10245 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty