Provider Demographics
NPI:1730244567
Name:BARNETT, RICHARD GEORGE (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GEORGE
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 1:3825 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6510
Mailing Address - Country:US
Mailing Address - Phone:605-335-2256
Mailing Address - Fax:605-335-7922
Practice Address - Street 1:3825 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6510
Practice Address - Country:US
Practice Address - Phone:605-335-2256
Practice Address - Fax:605-335-7922
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9202093Medicaid
SDT88829Medicare UPIN
SD9202093Medicaid