Provider Demographics
NPI:1982760310
Name:BARNISKE, DONALD LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEE
Last Name:BARNISKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2351
Mailing Address - Country:US
Mailing Address - Phone:760-351-2020
Mailing Address - Fax:760-344-4552
Practice Address - Street 1:260 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2351
Practice Address - Country:US
Practice Address - Phone:760-351-2020
Practice Address - Fax:760-344-4552
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5636T152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982760310Medicaid
CA1982760310Medicaid
CAT10062Medicare UPIN
CAWY2550Medicare ID - Type UnspecifiedMEDICARE NUMBER