Provider Demographics
NPI:1841302544
Name:BARK, STUART G (OD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:G
Last Name:BARK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:9815 E BELL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2341
Mailing Address - Country:US
Mailing Address - Phone:480-419-3900
Mailing Address - Fax:480-419-3943
Practice Address - Street 1:9815 E BELL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2341
Practice Address - Country:US
Practice Address - Phone:480-419-3900
Practice Address - Fax:480-419-3943
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ12152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0902340OtherBLUE CROSS BLUE SHIELD
AZ4961130002Medicare NSC
AZ4961130001Medicare NSC
AZZ70115Medicare PIN
AZAZ0902340OtherBLUE CROSS BLUE SHIELD