Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | R101-TA-207 | AL |
NPI | 1003816521 |
---|---|
Provider Name | Dr. Johnnie Paul Barnes |
First Address | Madison, AL 35758-8813 |
Second Address | Huntsville, AL 35802-2797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 10/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T93477 | (02) | AL |