Provider Demographics
NPI:1659491777
Name:BARNES, STEPHEN ALLEN (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALLEN
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 1:3639 CRATER LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9259
Mailing Address - Country:US
Mailing Address - Phone:541-734-2467
Mailing Address - Fax:541-734-2467
Practice Address - Street 1:3639 CRATER LAKE HWY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9259
Practice Address - Country:US
Practice Address - Phone:541-734-2467
Practice Address - Fax:541-858-5130
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1745ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000PHGTWMedicare UPIN