Provider Demographics
NPI:1164506556
Name:BARNETT, STEVEN CLINTON (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CLINTON
Last Name:BARNETT
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 1:106 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5137
Mailing Address - Country:US
Mailing Address - Phone:573-471-1814
Mailing Address - Fax:573-471-7039
Practice Address - Street 1:106 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5137
Practice Address - Country:US
Practice Address - Phone:573-471-1814
Practice Address - Fax:573-471-7039
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312640204Medicaid
MO000009966Medicare ID - Type Unspecified
MO312640204Medicaid
MO0186020001Medicare NSC