Provider Demographics
NPI:1912069808
Name:AUGUST, BARRY P (OD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:P
Last Name:AUGUST
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 1:1611 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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382476261OtherFEDERAL TAX ID
MIOF36633Medicare ID - Type Unspecified
MI382476261OtherFEDERAL TAX ID
MI0524680001Medicare NSC