Provider Demographics
NPI:1003816521
Name:BARNES, JOHNNIE PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNIE
Middle Name:PAUL
Last Name:BARNES
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 1:7771 HIGHWAY 72 W
Mailing Address - Street 2:SUITE D
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8813
Mailing Address - Country:US
Mailing Address - Phone:256-430-1700
Mailing Address - Fax:256-830-5132
Practice Address - Street 1:7105 BAILEY CREEK CIR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2797
Practice Address - Country:US
Practice Address - Phone:256-883-9082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR101-TA-207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT93477Medicare UPIN
AL000060615Medicare ID - Type Unspecified
AL5522180001Medicare NSC