Provider Demographics
NPI:1003892019
Name:BARNETT, MICHAEL R (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:BARNETT
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 1:4319 A LAWRENCEVILLE HWY
Mailing Address - Street 2:LILBURN EYECARE
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047
Mailing Address - Country:US
Mailing Address - Phone:770-921-4707
Mailing Address - Fax:770-925-8973
Practice Address - Street 1:4319 A LAWRENCEVILLE HWY
Practice Address - Street 2:LILBURN EYECARE
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047
Practice Address - Country:US
Practice Address - Phone:770-921-4707
Practice Address - Fax:770-925-8973
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA728T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410021154OtherMEDICARE RAILROAD
GA202I418862OtherPTAN
GAGRP1065OtherGROUP PTAN
GAGRP1065OtherGROUP PTAN
GA0154870002Medicare NSC