Provider Demographics
NPI:1912104985
Name:BARRIOS, JESUS L (OD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:L
Last Name:BARRIOS
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 1:221 US HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1921
Mailing Address - Country:US
Mailing Address - Phone:732-968-4114
Mailing Address - Fax:732-968-6966
Practice Address - Street 1:221 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1921
Practice Address - Country:US
Practice Address - Phone:732-968-4114
Practice Address - Fax:732-968-6966
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001902152W00000X
NJ27OA00624200152W00000X
FLOPC4494152W00000X
NYTUV007515152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ248410Medicaid