Provider Demographics
NPI:1366849598
Name:DR. B.J. BARNES, LLC
Entity Type:Organization
Organization Name:DR. B.J. BARNES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-736-8440
Mailing Address - Street 1:1751 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1125
Mailing Address - Country:US
Mailing Address - Phone:317-736-8440
Mailing Address - Fax:317-738-9426
Practice Address - Street 1:1751 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1125
Practice Address - Country:US
Practice Address - Phone:317-736-8440
Practice Address - Fax:317-738-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001639B332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100154490AMedicaid
INU13343Medicare UPIN
IN442320Medicare PIN