Healthcare Provider Details

I. General information

NPI: 1982896593
Provider Name (Legal Business Name): KYLE BARNES OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 HIGHWAY 92 S SUITE 7
DANDRIDGE TN
37725-4571
US

IV. Provider business mailing address

209 VISTA VIEW CT
DANDRIDGE TN
37725-6168
US

V. Phone/Fax

Practice location:
  • Phone: 865-397-9991
  • Fax: 865-940-1401
Mailing address:
  • Phone: 859-475-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2857
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1711DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: