Healthcare Provider Details

I. General information

NPI: 1396584652
Provider Name (Legal Business Name): ADAM JOSEPH BARTNICKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 MONTICELLO AVE STE A
WILLIAMSBURG VA
23188-8232
US

IV. Provider business mailing address

PO BOX 45923
BALTIMORE MD
21297-5923
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-4000
  • Fax: 757-220-2798
Mailing address:
  • Phone: 877-969-0392
  • Fax: 804-658-0582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003409
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: