1114345675 NPI number — DR. MARKITTA BARNETT

Table of content: (NPI 1114345675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114345675 NPI number — DR. MARKITTA BARNETT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. MARKITTA BARNETT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. MARKITTA BARNETT & ASSOCIATES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114345675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 592208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78259-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-223-1104
Provider Business Mailing Address Fax Number:
360-935-8560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2490 7TH ST
Provider Second Line Business Practice Location Address:
BLDG 372
Provider Business Practice Location Address City Name:
FORT SAM HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234-7613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-223-1104
Provider Business Practice Location Address Fax Number:
360-935-8560
Provider Enumeration Date:
04/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BARNETT
Authorized Official First Name:
MARKITTA
Authorized Official Middle Name:
SAMONE
Authorized Official Title or Position:
OWNER/ OPTOMETRIST
Authorized Official Telephone Number:
210-592-3641

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  7281T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 7774T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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