Healthcare Provider Details

I. General information

NPI: 1952596447
Provider Name (Legal Business Name): CESAR R. BARTELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE TRAVERSE DR
SISSETON SD
57262-7046
US

IV. Provider business mailing address

100 LAKE TRAVERSE DR
SISSETON SD
57262-7046
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7606
  • Fax:
Mailing address:
  • Phone: 951-316-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: