MEDICARE: DR. BARTON L. POWELL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	ODT1585	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164572285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARTON L. POWELL O.D.

Provider Business Mailing Address
First Line	:	3959 HERONS RETREAT CV
Second Line	:
City	:	LAKELAND
State	:	TN
Zip	:	38002-8498
Country	:	US
Telephone Number	:	901-867-9692
Fax Number	:

Provider Business Practice Location Address
First Line	:	2961 CANADA RD
Second Line	:	STE 104
City	:	LAKELAND
State	:	TN
Zip	:	38002-4893
Country	:	US
Telephone Number	:	901-380-2020
Fax Number	:	901-380-2809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/19/2012

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