Healthcare Provider Details

I. General information

NPI: 1124041298
Provider Name (Legal Business Name): BARBARA HORN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BARBARA HORN-WEISGERBER OD

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 48TH AVENUE N. #101
MYRTLE BEACH SC
29577-5434
US

IV. Provider business mailing address

950 48TH AVENUE N. #101
MYRTLE BEACH SC
29577-5434
US

V. Phone/Fax

Practice location:
  • Phone: 586-484-8448
  • Fax: 843-488-9659
Mailing address:
  • Phone: 586-484-8448
  • Fax: 843-488-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1926
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1926
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1926
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: