Provider Demographics
NPI:1396837324
Name:THOLEN, BARBARA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:MARIE
Last Name:THOLEN
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 1:1433 W HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3402
Mailing Address - Country:US
Mailing Address - Phone:512-858-1766
Mailing Address - Fax:512-858-1768
Practice Address - Street 1:1433 W HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3402
Practice Address - Country:US
Practice Address - Phone:512-858-1766
Practice Address - Fax:512-858-1768
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3695TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0410748-01Medicaid
TX82947EMedicare ID - Type Unspecified
TX0410748-01Medicaid