Provider Demographics
NPI:1831183540
Name:BARNETT, DEBRA JEANNE (OD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JEANNE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10314 83RD PL
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-2023
Mailing Address - Country:US
Mailing Address - Phone:262-697-3665
Mailing Address - Fax:262-653-0200
Practice Address - Street 1:6116 39TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7012
Practice Address - Country:US
Practice Address - Phone:262-653-0100
Practice Address - Fax:262-653-0200
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2407035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU25331Medicare UPIN
WIWI1065001Medicare PIN