Provider Demographics
NPI:1104911916
Name:BARTON, TRACE ADAM (OD)
Entity type:Individual
Prefix:DR
First Name:TRACE
Middle Name:ADAM
Last Name:BARTON
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 1:5389 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8765
Mailing Address - Country:US
Mailing Address - Phone:850-995-3232
Mailing Address - Fax:850-995-2606
Practice Address - Street 1:5389 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8765
Practice Address - Country:US
Practice Address - Phone:850-995-3232
Practice Address - Fax:850-995-2606
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3208152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20928OtherBCBS
FL20928OtherBCBS
FLU73450Medicare UPIN