MEDICARE: JENNIFER G. BARTOLOME OPTOMETRY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285131060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER G. BARTOLOME OPTOMETRY CORP

Provider Business Mailing Address
First Line	:	10977 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3341
Country	:	US
Telephone Number	:	818-763-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	10977 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3341
Country	:	US
Telephone Number	:	818-763-6666
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST/ CEO
Name	:	DR. JENNIFER BARTOLOME
Credential	:	OD
Telephone Number	:	818-763-6666

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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