Provider Demographics
NPI:1083783963
Name:BARNES, CHARLES E (OD PA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:BARNES
Suffix:
Gender:M
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0688
Mailing Address - Country:US
Mailing Address - Phone:601-684-6241
Mailing Address - Fax:601-684-0280
Practice Address - Street 1:414A MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2710
Practice Address - Country:US
Practice Address - Phone:601-684-6241
Practice Address - Fax:601-684-0280
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880058Medicaid
LA1393509OtherMEDICAID
MS00880058Medicaid
41000004Medicare ID - Type Unspecified