Healthcare Provider Details

I. General information

NPI: 1184607137
Provider Name (Legal Business Name): WILLIAM GEORGE BARTOLOVICH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DUTTON DR
YOUNGSTOWN OH
44502-1818
US

IV. Provider business mailing address

10 DUTTON DR
YOUNGSTOWN OH
44502-1818
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-7691
  • Fax: 330-743-8322
Mailing address:
  • Phone: 330-746-7691
  • Fax: 330-743-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number152WOOOOOX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: