Provider Demographics
NPI:1336340868
Name:WILLIAM A. BARNETT OD, PA
Entity Type:Organization
Organization Name:WILLIAM A. BARNETT OD, PA
Other - Org Name:SOUTH RIVER EYECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KETCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-956-2828
Mailing Address - Street 1:2979 SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1414
Mailing Address - Country:US
Mailing Address - Phone:410-956-2828
Mailing Address - Fax:410-956-2853
Practice Address - Street 1:2979 SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1414
Practice Address - Country:US
Practice Address - Phone:410-956-2828
Practice Address - Fax:410-956-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD656LMedicare ID - Type Unspecified