Provider Demographics
NPI:1306988167
Name:BARKER, CATHERINE PEARL (OD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:PEARL
Last Name:BARKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11777 SAN VICENTE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6623
Mailing Address - Country:US
Mailing Address - Phone:310-820-2020
Mailing Address - Fax:310-820-1884
Practice Address - Street 1:11777 SAN VICENTE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6623
Practice Address - Country:US
Practice Address - Phone:310-820-2020
Practice Address - Fax:310-820-1884
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11742T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0117420Medicaid
CASD0117420Medicaid
U87317Medicare UPIN