Healthcare Provider Details

I. General information

NPI: 1215102298
Provider Name (Legal Business Name): SCOTT RONALD BARNES OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 S 1300 E STE E210
SANDY UT
84094-3779
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-572-0631
  • Fax: 801-572-0670
Mailing address:
  • Phone: 801-232-1242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number363114-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: