Provider Demographics
NPI:1346331535
Name:BARNARD, KELVIN
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:
Last Name:BARNARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1324
Mailing Address - Country:US
Mailing Address - Phone:315-634-1608
Mailing Address - Fax:315-488-0047
Practice Address - Street 1:5633 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1324
Practice Address - Country:US
Practice Address - Phone:315-634-1608
Practice Address - Fax:315-488-0047
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005879156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5244700001Medicare NSC
NY5244700001Medicare NSC