Healthcare Provider Details

I. General information

NPI: 1285131060
Provider Name (Legal Business Name): JENNIFER G. BARTOLOME OPTOMETRY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10977 VENTURA BLVD
STUDIO CITY CA
91604-3341
US

IV. Provider business mailing address

10977 VENTURA BLVD
STUDIO CITY CA
91604-3341
US

V. Phone/Fax

Practice location:
  • Phone: 818-763-6666
  • Fax:
Mailing address:
  • Phone: 818-763-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JENNIFER BARTOLOME
Title or Position: OPTOMETRIST/ CEO
Credential: OD
Phone: 818-763-6666