Provider Demographics
NPI:1205015021
Name:ANDREA M. BARNHART, O.D.
Entity Type:Organization
Organization Name:ANDREA M. BARNHART, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-298-1154
Mailing Address - Street 1:3311 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5703
Mailing Address - Country:US
Mailing Address - Phone:619-298-1154
Mailing Address - Fax:619-296-8849
Practice Address - Street 1:3311 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5703
Practice Address - Country:US
Practice Address - Phone:619-298-1154
Practice Address - Fax:619-296-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12277T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP12277OtherMEDICARE
CA12277TOtherCA LICENSE
CA1114957180OtherINDIVIDUAL NPI
CAU96906Medicare UPIN