Provider Demographics
NPI:1306820188
Name:BARNES, DWIGHT W (OD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:W
Last Name:BARNES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 GREEN LEVEL CHURCH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8143
Mailing Address - Country:US
Mailing Address - Phone:919-465-7400
Mailing Address - Fax:919-465-7455
Practice Address - Street 1:10110 GREEN LEVEL CHURCH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8143
Practice Address - Country:US
Practice Address - Phone:919-465-7400
Practice Address - Fax:919-465-7455
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093TUOtherBLUE CROSS BLUE SHIELD
NC590161Medicaid
NC2473635AMedicare ID - Type Unspecified
NC2473635BMedicare ID - Type Unspecified
NC093TUOtherBLUE CROSS BLUE SHIELD
NC590161Medicaid