Provider Demographics
NPI:1962654947
Name:HERSCOVITCH, BARRY (LDO)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:HERSCOVITCH
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:BARRY
Other - Middle Name:
Other - Last Name:HERSCOVITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDO
Mailing Address - Street 1:4416 SENTRY PALM LOOP
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-5625
Mailing Address - Country:US
Mailing Address - Phone:352-999-2515
Mailing Address - Fax:
Practice Address - Street 1:4416 SENTRY PALM LOOP
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-5625
Practice Address - Country:US
Practice Address - Phone:352-999-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5836156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician