Provider Demographics
NPI:1366649162
Name:BARNES, RYAN CHRISTOPHER (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CHRISTOPHER
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 1:1324 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-9301
Mailing Address - Country:US
Mailing Address - Phone:773-792-1011
Mailing Address - Fax:773-787-1311
Practice Address - Street 1:6601 N AVONDALE AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1567
Practice Address - Country:US
Practice Address - Phone:773-792-1011
Practice Address - Fax:773-889-0224
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009949Medicaid
ILP00404130OtherRAILROAD MEDICARE
IL1622243OtherBCBS OF IL