Provider Demographics
NPI:1033592258
Name:BARRETT, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 WHITTLESEY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3031
Mailing Address - Country:US
Mailing Address - Phone:706-507-3937
Mailing Address - Fax:706-507-3929
Practice Address - Street 1:2501 WHITTLESEY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3031
Practice Address - Country:US
Practice Address - Phone:706-507-3937
Practice Address - Fax:706-507-3929
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist