Provider Demographics
NPI:1679544514
Name:BARR, WARREN PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:PAUL
Last Name:BARR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 ARTESIA BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2755
Mailing Address - Country:US
Mailing Address - Phone:310-372-5213
Mailing Address - Fax:310-798-2809
Practice Address - Street 1:1200 ARTESIA BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2755
Practice Address - Country:US
Practice Address - Phone:310-372-5213
Practice Address - Fax:310-798-2809
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6867TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT70148Medicare UPIN
CAOP6867Medicare PIN
CA4285400001Medicare NSC