Provider Demographics
NPI:1467466540
Name:BARNHART, BLAINE (OD)
Entity Type:Individual
Prefix:
First Name:BLAINE
Middle Name:
Last Name:BARNHART
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 1:738 W 600 N
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-9717
Mailing Address - Country:US
Mailing Address - Phone:317-919-8995
Mailing Address - Fax:317-837-4093
Practice Address - Street 1:2373 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2717
Practice Address - Country:US
Practice Address - Phone:317-839-0713
Practice Address - Fax:317-837-4093
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003401A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200858190Medicaid
INV118899Medicare UPIN
IN257580AMedicare PIN