Healthcare Provider Details

I. General information

NPI: 1336340868
Provider Name (Legal Business Name): WILLIAM A. BARNETT OD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2979 SOLOMONS ISLAND RD
EDGEWATER MD
21037-1414
US

IV. Provider business mailing address

2979 SOLOMONS ISLAND RD
EDGEWATER MD
21037-1414
US

V. Phone/Fax

Practice location:
  • Phone: 410-956-2828
  • Fax: 410-956-2853
Mailing address:
  • Phone: 410-956-2828
  • Fax: 410-956-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA KETCHEM
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-956-2828