Provider Demographics
NPI:1669509899
Name:BARNES, KELLY CHRISTINE (OD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CHRISTINE
Last Name:BARNES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10110 GREEN LEVEL CHURCH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8143
Mailing Address - Country:US
Mailing Address - Phone:919-465-7400
Mailing Address - Fax:919-465-7455
Practice Address - Street 1:10110 GREEN LEVEL CHURCH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8143
Practice Address - Country:US
Practice Address - Phone:919-465-7400
Practice Address - Fax:919-465-7455
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU92865Medicare UPIN