Provider Demographics
NPI:1124041298
Name:HORN, BARBARA (OD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:HORN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:HORN-WEISGERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:950 48TH AVENUE N.
Mailing Address - Street 2:#101
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5434
Mailing Address - Country:US
Mailing Address - Phone:586-484-8448
Mailing Address - Fax:843-488-9659
Practice Address - Street 1:950 48TH AVENUE N.
Practice Address - Street 2:#101
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5434
Practice Address - Country:US
Practice Address - Phone:586-484-8448
Practice Address - Fax:843-488-9659
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1926152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC79242614Medicaid
MI0P30340Medicare PIN
MI900E018310Medicare UPIN