Provider Demographics
NPI:1548499676
Name:BARTH, TARA RAE (OD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:RAE
Last Name:BARTH
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 1:9801 DUPONT AVE S
Mailing Address - Street 2:STE 425
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3100
Mailing Address - Country:US
Mailing Address - Phone:952-888-5800
Mailing Address - Fax:952-567-6176
Practice Address - Street 1:9801 DUPONT AVE S
Practice Address - Street 2:STE 200
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3100
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:952-567-6176
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3167152WC0802X, 152W00000X
OK2595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management