Provider Demographics
NPI:1043274947
Name:BARRY, TIMOTHY JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:BARRY
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 1:1245 S COLLEGE RD BLDG 3
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2917
Mailing Address - Country:US
Mailing Address - Phone:337-541-1700
Mailing Address - Fax:337-534-4992
Practice Address - Street 1:1245 S COLLEGE RD BLDG 3
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2917
Practice Address - Country:US
Practice Address - Phone:337-541-1700
Practice Address - Fax:337-534-4992
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04948T152W00000X
LA1192-344T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1998273Medicaid
LA1998273Medicaid