Individual
MR. BARTON MILO PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
56970 YUCCA TRL, YUCCA VALLEY, CA 92284-3753
(760) 228-2020
(760) 369-2020
Mailing address
56970 YUCCA TRL, YUCCA VALLEY, CA 92284-3753
(760) 228-2020
(760) 369-2020
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
OPT4600T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0313520001
DMERC M/C REGION D
CA
01
—
1124224589
GROUP NPI
CA
01
—
410004661
RAILROAD MEDICARE
CA
01
—
GSD004460
MEDICAID GROUP NUMBER
CA
05
—
SD0046000
—
CA
01
—
ZZZ24908Z
MEDICARE CLINIC GROUP NUM
CA
Enumeration date
11/30/2005
Last updated
03/02/2010
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