Healthcare Provider Details

I. General information

NPI: 1689981953
Provider Name (Legal Business Name): BARTHELEMY'S OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 07/22/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 BEMISS RD SUITE A
VALDOSTA GA
31602-1942
US

IV. Provider business mailing address

2236 BEMISS RD SUITE A
VALDOSTA GA
31602-1942
US

V. Phone/Fax

Practice location:
  • Phone: 229-249-7907
  • Fax: 229-241-8891
Mailing address:
  • Phone: 229-249-7907
  • Fax: 229-241-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0844
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberLDO 002099
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANASTASIA ALYSSE BARTHELEMY BROWN
Title or Position: MANAGER
Credential:
Phone: 504-372-6326