=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457803173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN C BARNETT OD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2016
-----------------------------------------------------
Last Update Date | 10/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 PLAZA DR
-----------------------------------------------------
City | SIKESTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63801-5137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-471-1814
-----------------------------------------------------
Fax | 573-471-7039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 PLAZA DR
-----------------------------------------------------
City | SIKESTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63801-5137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-471-1814
-----------------------------------------------------
Fax | 573-471-7039
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEVEN CLINTON BARNETT
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 573-471-1814
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | T02574
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------