Provider Demographics
NPI:1023181567
Name:DESMONE, BARBARA ANN (OD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:DESMONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-2214
Mailing Address - Country:US
Mailing Address - Phone:252-447-2768
Mailing Address - Fax:888-774-3877
Practice Address - Street 1:306 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2214
Practice Address - Country:US
Practice Address - Phone:252-447-2768
Practice Address - Fax:888-774-3877
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909588Medicaid
NC09588OtherBLUE CROSS BLUE SHIELD
NC8909588Medicaid
NC09588OtherBLUE CROSS BLUE SHIELD