Provider Demographics
NPI:1417019662
Name:BARNES, GARY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
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 1:931 ANZA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4531
Mailing Address - Country:US
Mailing Address - Phone:760-758-3944
Mailing Address - Fax:760-758-2063
Practice Address - Street 1:931 ANZA AVE STE B
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4531
Practice Address - Country:US
Practice Address - Phone:760-758-3944
Practice Address - Fax:760-758-2063
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0052340Medicaid
CAT-69998Medicare UPIN