Provider Demographics
NPI:1912907106
Name:MILLIS, BARRY G (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:G
Last Name:MILLIS
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 1:352 GRIBBEL RD
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1108
Mailing Address - Country:US
Mailing Address - Phone:215-206-8526
Mailing Address - Fax:
Practice Address - Street 1:352 GRIBBEL RD
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1108
Practice Address - Country:US
Practice Address - Phone:215-206-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 000162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28509Medicare UPIN
PA025030Medicare ID - Type UnspecifiedPROVIDER NUMBER