Provider Demographics
NPI:1619180999
Name:BARNES VISION CLINIC, INC.
Entity Type:Organization
Organization Name:BARNES VISION CLINIC, INC.
Other - Org Name:BARNES VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROYSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-223-0055
Mailing Address - Street 1:1911 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1382
Mailing Address - Country:US
Mailing Address - Phone:580-223-0055
Mailing Address - Fax:580-223-0776
Practice Address - Street 1:1911 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1382
Practice Address - Country:US
Practice Address - Phone:580-223-0055
Practice Address - Fax:580-223-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK249506302Medicare ID - Type UnspecifiedDR. COLE'S INDIVIDUAL #
OKV03994Medicare UPIN
OKU37609Medicare UPIN
OK249506303Medicare ID - Type UnspecifiedDR. BARNES INDIVIDUAL #
OK1143270001Medicare NSC
OK900522242Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER