Provider Demographics
NPI:1073668307
Name:DRS. BARNETT, ANDERSEN, & ASSOCIATES, OPTOMETRIST, P.C.
Entity Type:Organization
Organization Name:DRS. BARNETT, ANDERSEN, & ASSOCIATES, OPTOMETRIST, P.C.
Other - Org Name:DRS. BRAUTIGAM, BARNETT, ANDERSEN, & ASSOCIATES, OPTOMETRIST, P.C
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEIF
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-921-4707
Mailing Address - Street 1:4319 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3416
Mailing Address - Country:US
Mailing Address - Phone:770-921-4707
Mailing Address - Fax:770-925-8973
Practice Address - Street 1:4319 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3416
Practice Address - Country:US
Practice Address - Phone:770-921-4707
Practice Address - Fax:770-925-8973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA683T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA377696987AMedicaid
GA238123293AMedicaid
GA238123293AMedicaid
GAV12058Medicare UPIN
GA55317054SAMedicare PIN
GA41ZCCRKMedicare PIN
GA0154870002Medicare NSC
GA437788819AMedicare PIN
GAU22207Medicare UPIN
GA377696987AMedicaid
GA41ZCGHRMedicare PIN