Provider Demographics
NPI:1982896593
Name:BARNES, KYLE (OD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
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 1:209 VISTA VIEW CT
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-6168
Mailing Address - Country:US
Mailing Address - Phone:859-475-3363
Mailing Address - Fax:
Practice Address - Street 1:334 HIGHWAY 92 S
Practice Address - Street 2:SUITE 7
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4571
Practice Address - Country:US
Practice Address - Phone:865-397-9991
Practice Address - Fax:865-940-1401
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2857152W00000X
KY1711DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100018110Medicaid
TN1519327Medicaid
KY7100018110Medicaid