Provider Demographics
NPI:1073598348
Name:BARRETT, BOB H (OD)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:H
Last Name:BARRETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:H
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 FULDNER RD
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-7319
Mailing Address - Country:US
Mailing Address - Phone:803-259-5155
Mailing Address - Fax:803-259-0785
Practice Address - Street 1:30 FULDNER RD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-7319
Practice Address - Country:US
Practice Address - Phone:803-259-5155
Practice Address - Fax:803-259-0785
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC318931Medicaid
GA41ZCFWTMedicaid
SCAA46999430Medicare PIN
GA41ZCFWTMedicaid
T23692Medicare UPIN