Provider Demographics
NPI:1588408413
Name:BARRON, MADELINE (OD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:BARRON
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 1:36TH MEDICAL GROUP
Mailing Address - Street 2:UNIT 14010 BLDG. 26012
Mailing Address - City:ANDERSEN AFB APO
Mailing Address - State:AP
Mailing Address - Zip Code:96543-4003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36TH MEDICAL GROUP
Practice Address - Street 2:UNIT 14010 BLDG. 26012
Practice Address - City:ANDERSEN AFB APO
Practice Address - State:AP
Practice Address - Zip Code:96543-4003
Practice Address - Country:US
Practice Address - Phone:920-621-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0004050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist