Provider Demographics
NPI:1295859239
Name:MICHELLE BARNES OPTOMETRY, P.C
Entity Type:Organization
Organization Name:MICHELLE BARNES OPTOMETRY, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-327-5466
Mailing Address - Street 1:805 S LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-3030
Mailing Address - Country:US
Mailing Address - Phone:814-942-7184
Mailing Address - Fax:814-942-7137
Practice Address - Street 1:805 S LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-3030
Practice Address - Country:US
Practice Address - Phone:814-942-7184
Practice Address - Fax:814-942-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000543152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01660472Medicaid
PA108215OtherPETAN
PA01660472Medicaid