Provider Demographics
NPI:1891514477
Name:PANNELL, BARRETT (OD)
Entity type:Individual
Prefix:DR
First Name:BARRETT
Middle Name:
Last Name:PANNELL
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 1:2512 SAINT ANDREW CT
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-8539
Mailing Address - Country:US
Mailing Address - Phone:316-833-2534
Mailing Address - Fax:
Practice Address - Street 1:230 S HIGHWAY 97 STE B
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-6571
Practice Address - Country:US
Practice Address - Phone:918-241-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist