Provider Demographics
NPI:1275503476
Name:BARNES, ALISA RENAI (OD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:RENAI
Last Name:BARNES
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 1:623 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3201
Mailing Address - Country:US
Mailing Address - Phone:213-629-4691
Mailing Address - Fax:213-629-0758
Practice Address - Street 1:623 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3201
Practice Address - Country:US
Practice Address - Phone:213-629-4691
Practice Address - Fax:213-629-0758
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9434T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0094341Medicaid
CASD0094341Medicaid
CAU55678Medicare UPIN