Provider Demographics
NPI:1801319538
Name:BARREDA, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BARREDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3948 W 26TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3740
Mailing Address - Country:US
Mailing Address - Phone:773-542-2020
Mailing Address - Fax:773-542-7050
Practice Address - Street 1:3948 W 26TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3740
Practice Address - Country:US
Practice Address - Phone:773-542-2020
Practice Address - Fax:773-542-7050
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician