Basic Information
| Provider Information | |||||||||
| NPI: | 1366649162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3329 BROMLEY LN | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605026535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737921011 | ||||||||
| FaxNumber: | 7738890224 | ||||||||
| Practice Location | |||||||||
| Address1: | 6601 N AVONDALE AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606311567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737921011 | ||||||||
| FaxNumber: | 7738890224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 12/05/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046009949 | IL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 046009949 | 05 | IL | MEDICAID | P00404130 | 01 | IL | RAILROAD MEDICARE | OTHER | 1622243 | 01 | IL | BCBS OF IL | OTHER |