Provider Demographics
NPI:1295875078
Name:MCNAMARA, BARRY J (OD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:J
Last Name:MCNAMARA
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 1:605 JASMINE TRL
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-3661
Mailing Address - Country:US
Mailing Address - Phone:334-365-2020
Mailing Address - Fax:334-365-4845
Practice Address - Street 1:605 JASMINE TRL
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-3661
Practice Address - Country:US
Practice Address - Phone:334-365-2020
Practice Address - Fax:334-365-4845
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS398TA100152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529401860Medicaid
AL51058560OtherBLUE CROSS BLUE SHIELD
AL51058560OtherBLUE CROSS BLUE SHIELD
AL631111529OtherEIN NUMBER
AL000058560Medicare ID - Type Unspecified
AL0772530001Medicare NSC