Provider Demographics
NPI:1609176031
Name:BARNES VISION OF ELIZABETHTON
Entity Type:Organization
Organization Name:BARNES VISION OF ELIZABETHTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-475-3363
Mailing Address - Street 1:1001 OVER MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2855
Mailing Address - Country:US
Mailing Address - Phone:423-543-3293
Mailing Address - Fax:423-543-8305
Practice Address - Street 1:1001 OVER MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2855
Practice Address - Country:US
Practice Address - Phone:423-543-3293
Practice Address - Fax:423-543-8305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARNES VISION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty