Provider Demographics
NPI:1023071123
Name:BARKER, JILL MARIE (OD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:BARKER
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 1:207 CLARENCE DR SW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663
Mailing Address - Country:US
Mailing Address - Phone:330-339-6070
Mailing Address - Fax:
Practice Address - Street 1:143 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-1106
Practice Address - Country:US
Practice Address - Phone:740-942-4433
Practice Address - Fax:740-942-3897
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2061478Medicaid
OH0820507Medicare PIN
OHU65730Medicare UPIN