Healthcare Provider Details

I. General information

NPI: 1164430203
Provider Name (Legal Business Name): JIMMY D. BARTLETT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 UNIVERSITY BLVD HPB G080A
BIRMINGHAM AL
35294-0010
US

IV. Provider business mailing address

1716 UNIVERSITY BLVD HPB GO80A
BIRMINGHAM AL
35294-0010
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-2020
  • Fax: 205-934-6755
Mailing address:
  • Phone: 205-934-4748
  • Fax: 205-934-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT-29-TA-008
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: