Provider Demographics
NPI:1427322429
Name:BARRY P. AUGUST O.D.,P.C.
Entity type:Organization
Organization Name:BARRY P. AUGUST O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REANNAN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-858-2535
Mailing Address - Street 1:1611 S OPDYKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1043
Mailing Address - Country:US
Mailing Address - Phone:248-858-2535
Mailing Address - Fax:248-858-2403
Practice Address - Street 1:1611 S OPDYKE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-1043
Practice Address - Country:US
Practice Address - Phone:248-858-2535
Practice Address - Fax:248-858-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5353Medicare PIN