Healthcare Provider Details

I. General information

NPI: 1255308847
Provider Name (Legal Business Name): CHRIS L BARTELSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SANTA BARBARA ST SUITE C
SANTA PAULA CA
93060-2675
US

IV. Provider business mailing address

400 E SANTA BARBARA ST SUITE C
SANTA PAULA CA
93060-2675
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-6603
  • Fax: 805-525-6115
Mailing address:
  • Phone: 805-525-6603
  • Fax: 805-525-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5055T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: