Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3208 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3208 | FL |
NPI | 1104911916 |
---|---|
Provider Name | Dr. Trace Adam Barton |
First Address | Pace, FL 32571-8765 |
Second Address | Pace, FL 32571-8765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 14/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20928 | BCBS (01) | FL |
U73450 | (02) | FL |