Provider Demographics
NPI:1871759803
Name:BARNES, CHARLEY EDWARD (OD)
Entity type:Individual
Prefix:
First Name:CHARLEY
Middle Name:EDWARD
Last Name:BARNES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1125
Mailing Address - Country:US
Mailing Address - Phone:317-736-8440
Mailing Address - Fax:800-888-4760
Practice Address - Street 1:1751 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1125
Practice Address - Country:US
Practice Address - Phone:317-736-8440
Practice Address - Fax:800-888-4760
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U33619Medicare UPIN
596590Medicare PIN