Provider Demographics
NPI:1245384338
Name:BARRETT, LEEANN (OD)
Entity Type:Individual
Prefix:DR
First Name:LEEANN
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W BROADWAY BUSINESS PARK CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0106
Mailing Address - Country:US
Mailing Address - Phone:573-446-1600
Mailing Address - Fax:573-446-1605
Practice Address - Street 1:3301 W BROADWAY BUSINESS PARK CT
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0106
Practice Address - Country:US
Practice Address - Phone:573-446-1600
Practice Address - Fax:573-446-1605
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
116971OtherBCBC PROVIDER #
MO312457203Medicaid
MO4226OtherHEALTHCARE USA
MO312457203Medicaid