Provider Demographics
NPI:1578384624
Name:HATALA, BARBARA (LDO)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:HATALA
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1957
Mailing Address - Country:US
Mailing Address - Phone:607-368-0945
Mailing Address - Fax:
Practice Address - Street 1:1400 COUNTY ROUTE 64
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2297
Practice Address - Country:US
Practice Address - Phone:607-739-5209
Practice Address - Fax:607-739-5370
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY7203156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician