Provider Demographics
NPI:1255500757
Name:GARY L BARNES OD OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:GARY L BARNES OD OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-758-3044
Mailing Address - Street 1:931 ANZA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4531
Mailing Address - Country:US
Mailing Address - Phone:760-758-3944
Mailing Address - Fax:760-758-2063
Practice Address - Street 1:931 ANZA AVE STE B
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4531
Practice Address - Country:US
Practice Address - Phone:760-758-3944
Practice Address - Fax:760-758-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5234305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6002950001Medicare NSC
CAW22047Medicare PIN