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General NPI Number Information
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NPI Number | 1609176031
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Entity Type | Organization
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Legal Business Name | BARNES VISION OF ELIZABETHTON
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 1001 OVER MOUNTAIN DR
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City | ELIZABETHTON
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State | TN
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Zip | 37643-2855
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Country | US
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Telephone | 423-543-3293
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Fax | 423-543-8305
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Provider Business Mailing Address
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Address Line | 1001 OVER MOUNTAIN DR
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City | ELIZABETHTON
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State | TN
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Zip | 37643-2855
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Country | US
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Telephone | 423-543-3293
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Fax | 423-543-8305
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Authorized Official
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Title or Position | MEMBER/ OWNER
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Name | DR. KYLE BARNES
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Credential | O.D.
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Telephone | 859-475-3363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2857
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License Number State | TN
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