Provider Demographics
NPI:1265589477
Name:MODLINSKI-HAUGEN, BARBARA (OD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:MODLINSKI-HAUGEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:MODLINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:275 W MACARTHUR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5641
Mailing Address - Country:US
Mailing Address - Phone:510-752-1000
Mailing Address - Fax:510-752-1650
Practice Address - Street 1:275 W MACARTHUR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5641
Practice Address - Country:US
Practice Address - Phone:510-752-1000
Practice Address - Fax:510-752-1650
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9311T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist