Provider Demographics
NPI:1871631937
Name:BARRETT, RHONDA VESTAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:VESTAL
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RHONDA
Other - Middle Name:YVONNE
Other - Last Name:VESTAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1565 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3421
Mailing Address - Country:US
Mailing Address - Phone:803-328-0168
Mailing Address - Fax:803-325-8473
Practice Address - Street 1:1565 EBENEZER RD.
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3421
Practice Address - Country:US
Practice Address - Phone:803-328-0168
Practice Address - Fax:803-325-8473
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243001207W00000X
SCTL31683207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC31683OtherLICENSE #
NY02871887Medicaid
SCAA4321Medicare UPIN
NY02871887Medicaid