Provider Demographics
NPI:1295831303
Name:BARNES, TERRA J (DO)
Entity Type:Individual
Prefix:DR
First Name:TERRA
Middle Name:J
Last Name:BARNES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24361 EL TORO RD STE 180
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-2756
Mailing Address - Country:US
Mailing Address - Phone:949-458-2040
Mailing Address - Fax:949-458-2064
Practice Address - Street 1:24361 EL TORO RD STE 180
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2756
Practice Address - Country:US
Practice Address - Phone:949-458-2040
Practice Address - Fax:949-458-2064
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10283152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0102830Medicaid
CA11-3663840OtherTAX ID
CASD0102830Medicaid
CAOP10283Medicare ID - Type Unspecified