Provider Demographics
NPI:1902922636
Name:BARNETT, CARLA DIANE (OD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:DIANE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CATAMARAN DR
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1204
Mailing Address - Country:US
Mailing Address - Phone:949-640-2023
Mailing Address - Fax:
Practice Address - Street 1:400 NEWPORT CENTER DR STE 404
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7687
Practice Address - Country:US
Practice Address - Phone:949-640-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6866TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist