Provider Demographics
NPI:1255495727
Name:BARNETT, JAMES MICHAEL SR (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:BARNETT
Suffix:SR
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 1:3825 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6510
Mailing Address - Country:US
Mailing Address - Phone:605-335-7757
Mailing Address - Fax:605-335-7922
Practice Address - Street 1:3825 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6510
Practice Address - Country:US
Practice Address - Phone:605-335-7757
Practice Address - Fax:605-335-7922
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS75009Medicaid
SD92000590Medicaid
SD92000590Medicaid
SDT66610Medicare UPIN