Provider Demographics
NPI:1275792244
Name:BARNHART OPTOMETRY PC
Entity Type:Organization
Organization Name:BARNHART OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-831-2198
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:IN
Mailing Address - Zip Code:46111-0003
Mailing Address - Country:US
Mailing Address - Phone:317-831-2198
Mailing Address - Fax:
Practice Address - Street 1:2372 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2717
Practice Address - Country:US
Practice Address - Phone:317-839-0713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200912780AMedicaid
IN200912780BMedicaid
IN257580Medicare PIN
IN200912780AMedicaid