Healthcare Provider Details

I. General information

NPI: 1487654117
Provider Name (Legal Business Name): THOMAS A BARNARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 PRIMERA BLVD
LAKE MARY FL
32746-2175
US

IV. Provider business mailing address

8786 PERIMETER PARK BLVD
JACKSONVILLE FL
32216-6347
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-1570
  • Fax: 407-333-1381
Mailing address:
  • Phone: 904-997-9202
  • Fax: 904-996-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME75734
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0075734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: