Provider Demographics
NPI:1922101880
Name:DAVIS, BARRY (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:DAVIS
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 1:548 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3864
Mailing Address - Country:US
Mailing Address - Phone:201-339-4375
Mailing Address - Fax:201-339-0105
Practice Address - Street 1:548 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-339-4375
Practice Address - Fax:201-339-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYU10238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7448201Medicaid
NY112584558OtherEMPLOYER ID