Provider Demographics
NPI:1588725261
Name:BARKLEY, JEFFERSON WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:WAYNE
Last Name:BARKLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:KS
Mailing Address - Zip Code:66762
Mailing Address - Country:US
Mailing Address - Phone:620-231-2010
Mailing Address - Fax:620-230-0290
Practice Address - Street 1:2716 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:KS
Practice Address - Zip Code:66762
Practice Address - Country:US
Practice Address - Phone:620-231-2010
Practice Address - Fax:620-230-0290
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1345152W00000X
MOT02980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS411070OtherFIRST GUARD
650806OtherBLUE CROSS BLUE SHIELD
13371OtherSPECTERA
47658OtherDAVIS VISION
BA1336943OtherCLARITY VISION
KS10039522019Medicaid
BA1336943OtherCLARITY VISION
13371OtherSPECTERA