Provider Demographics
NPI:1720279474
Name:BARNWELL EYE CENTER
Entity Type:Organization
Organization Name:BARNWELL EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-259-5155
Mailing Address - Street 1:30 FULDNER RD
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-7319
Mailing Address - Country:US
Mailing Address - Phone:803-259-5155
Mailing Address - Fax:
Practice Address - Street 1:30 FULDNER RD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-7319
Practice Address - Country:US
Practice Address - Phone:803-259-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA384825893AMedicaid
GA41ZCFWTMedicare PIN
SC1091200001Medicare NSC
SCT236922375Medicare PIN
GAT23692Medicare UPIN
GAGRP7384Medicare PIN