Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 27OA00471800 | NJ |
NPI | 1003872144 |
---|---|
Provider Name | Dr. Frank Barnes JR. |
First Address | Montclair, NJ 07042-3130 |
Second Address | Montclair, NJ 07042-4451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 10/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0470201 | (05) | NJ |
T81285 | (02) | NJ |