Provider Demographics
NPI:1396749123
Name:BARR, DALE IRVIN (OD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:IRVIN
Last Name:BARR
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 1:3273 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-3074
Mailing Address - Country:US
Mailing Address - Phone:408-249-8464
Mailing Address - Fax:
Practice Address - Street 1:2730 UNION AVE
Practice Address - Street 2:STE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-1431
Practice Address - Country:US
Practice Address - Phone:408-371-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9931TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0681170001OtherMEDICARE CIGNA DMERC
CASD0099310Medicaid
CASD0099310Medicaid
CA0681170001OtherMEDICARE CIGNA DMERC