Provider Demographics
NPI:1710974183
Name:BARLOW, MARK ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:BARLOW
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:PO BOX 736480
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1407
Mailing Address - Country:US
Mailing Address - Phone:314-633-8575
Mailing Address - Fax:314-743-8399
Practice Address - Street 1:7331 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4405
Practice Address - Country:US
Practice Address - Phone:314-633-8575
Practice Address - Fax:314-362-3725
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013007905152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO310075018Medicaid
IL180035689OtherMEDICARE RAILROAD
051448OtherHEALTH ALLIANCE
802258OtherEYEMED
IL0814870009OtherMEDICARE NSC NUMBER
IL0814870024OtherMEDICARE NSC NUMBER
IL0814870010OtherMEDICARE NSC NUMBER
IL0814870023OtherMEDICARE NSC NUMBER
802258OtherEYEMED
U57608Medicare UPIN
IL180035689OtherMEDICARE RAILROAD
IL0814870010OtherMEDICARE NSC NUMBER