Provider Demographics
NPI:1326298704
Name:DR. CHUCK BARNES, PA
Entity Type:Organization
Organization Name:DR. CHUCK BARNES, PA
Other - Org Name:FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD PA
Authorized Official - Phone:601-684-6241
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0688
Mailing Address - Country:US
Mailing Address - Phone:601-684-6241
Mailing Address - Fax:601-684-0280
Practice Address - Street 1:414A MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2710
Practice Address - Country:US
Practice Address - Phone:601-684-6241
Practice Address - Fax:601-684-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1393509OtherMEDICAID
MS00880058Medicaid
MS41000004OtherMEDICARE ID-TYPE UNSPECIFIED
MST20956Medicare UPIN