Provider Demographics
NPI:1255062691
Name:BARTH VISION SURGICAL SUITE LLC
Entity type:Organization
Organization Name:BARTH VISION SURGICAL SUITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-955-1120
Mailing Address - Street 1:1035 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6608
Mailing Address - Country:US
Mailing Address - Phone:707-955-1120
Mailing Address - Fax:
Practice Address - Street 1:1035 2ND ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6608
Practice Address - Country:US
Practice Address - Phone:707-955-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery