Provider Demographics
NPI:1245390913
Name:JUSTIN BARNETT OD, PA
Entity Type:Organization
Organization Name:JUSTIN BARNETT OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-935-1326
Mailing Address - Street 1:5120 HIGHWAY 78
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-4243
Mailing Address - Country:US
Mailing Address - Phone:972-530-2020
Mailing Address - Fax:972-530-3315
Practice Address - Street 1:5120 HIGHWAY 78
Practice Address - Street 2:SUITE 700
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-4243
Practice Address - Country:US
Practice Address - Phone:972-530-2020
Practice Address - Fax:972-530-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6922TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X385Medicare PIN
V11986Medicare UPIN