Provider Demographics
NPI:1649478819
Name:BARNETT, MARKITTA S (OD)
Entity type:Individual
Prefix:DR
First Name:MARKITTA
Middle Name:S
Last Name:BARNETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARKITTA
Other - Middle Name:S
Other - Last Name:JEMERSON-DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1610 BUNCHBERRY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4438
Mailing Address - Country:US
Mailing Address - Phone:210-223-1104
Mailing Address - Fax:210-223-6063
Practice Address - Street 1:2515 FUNSTON RD STE A0010
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7667
Practice Address - Country:US
Practice Address - Phone:210-223-1104
Practice Address - Fax:210-223-6063
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2048152W00000X
AK348152W00000X
TX7281T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11717323OtherCAQH
TXTXB128141Medicare PIN
NC2474414Medicare PIN