Provider Demographics
NPI:1114345675
Name:DR. MARKITTA BARNETT
Entity Type:Organization
Organization Name:DR. MARKITTA BARNETT
Other - Org Name:DR. MARKITTA BARNETT & ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARKITTA
Authorized Official - Middle Name:SAMONE
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-592-3641
Mailing Address - Street 1:PO BOX 592208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0160
Mailing Address - Country:US
Mailing Address - Phone:210-223-1104
Mailing Address - Fax:360-935-8560
Practice Address - Street 1:2490 7TH ST
Practice Address - Street 2:BLDG 372
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7613
Practice Address - Country:US
Practice Address - Phone:210-223-1104
Practice Address - Fax:360-935-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7281T152W00000X
TX7774T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB128141Medicare PIN