Provider Demographics
NPI:1649304775
Name:PIVNICK, BARRY S (OD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:S
Last Name:PIVNICK
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 1:6712 SOUTHPORT DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6921
Mailing Address - Country:US
Mailing Address - Phone:561-737-8183
Mailing Address - Fax:
Practice Address - Street 1:6712 SOUTHPORT DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6921
Practice Address - Country:US
Practice Address - Phone:561-737-8183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist