Provider Demographics
NPI:1225184914
Name:BARNES, RAYMOND DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DOUGLAS
Last Name:BARNES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2989 SHELBURNE RD
Mailing Address - Street 2:ST12
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6369
Mailing Address - Country:US
Mailing Address - Phone:802-985-8338
Mailing Address - Fax:
Practice Address - Street 1:2989 SHELBURNE RD
Practice Address - Street 2:ST12
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6369
Practice Address - Country:US
Practice Address - Phone:802-985-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT-9635-41Medicare ID - Type Unspecified
VTT59320Medicare UPIN