Provider Demographics
NPI:1124099502
Name:BARKER, AMANDA LEIGH (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEIGH
Last Name:BARKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7547 WATERSIDE LOOP RD
Mailing Address - Street 2:STE A
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7677
Mailing Address - Country:US
Mailing Address - Phone:704-822-9920
Mailing Address - Fax:704-822-1764
Practice Address - Street 1:7547 WATERSIDE LOOP RD
Practice Address - Street 2:STE A
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7678
Practice Address - Country:US
Practice Address - Phone:704-822-9920
Practice Address - Fax:704-822-1764
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 1851152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120531OtherMAMSI LIFE AND HEALTH
C8178OtherMEDCOST INC
2472315AOtherMEDICARE COMPLETE
093K3OtherBLUE SHIELD
NC1851OtherEYEMED VISION CARE
802245OtherCOMMUNITY EYE CARE
2472315AOtherMEDICARE CIGNA
NC89093K3Medicaid
89093K3OtherDMA PROVIDER SERVICES
NC1851OtherEYEMED VISION CARE
2472315AOtherMEDICARE COMPLETE
2472315AOtherMEDICARE CIGNA