Provider Demographics
NPI:1386687432
Name:BARNES, DEBRA MAXINE (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:MAXINE
Last Name:BARNES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17323 1H 35 NORTH
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154
Mailing Address - Country:US
Mailing Address - Phone:210-651-5800
Mailing Address - Fax:210-651-9733
Practice Address - Street 1:17323 1H 35 NORTH
Practice Address - Street 2:SUITE 110
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154
Practice Address - Country:US
Practice Address - Phone:210-651-5800
Practice Address - Fax:210-651-9733
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3140TG152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX03140TGOtherTEXAS OPTOMETRY LICENSE
TX019433401Medicaid
TX8B6197Medicare PIN
TX03140TGOtherTEXAS OPTOMETRY LICENSE