Basic Information
| Provider Information | |||||||||
| NPI: | 1184988727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | KACY | ||||||||
| MiddleName: | WHITING | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 TOWNE CENTER BLVD 502 | ||||||||
| Address2: | |||||||||
| City: | POOLER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313224068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127481272 | ||||||||
| FaxNumber: | 9127481996 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 NORTHSIDE DR E | ||||||||
| Address2: | |||||||||
| City: | STATESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304584839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127649147 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2012 | ||||||||
| LastUpdateDate: | 09/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT002700 | GA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.