Healthcare Provider Details

I. General information

NPI: 1356551329
Provider Name (Legal Business Name): ROY BARTLETT DO PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14050 JUANITA DR NE SUITE A
BOTHELL WA
98011-5308
US

IV. Provider business mailing address

14050 JUANITA DR NE SUITE A
BOTHELL WA
98011-5308
US

V. Phone/Fax

Practice location:
  • Phone: 425-820-2020
  • Fax:
Mailing address:
  • Phone: 425-820-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00003802
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOP00000732
License Number StateWA

VIII. Authorized Official

Name: DR. ROY WILLIAM BARTLETT
Title or Position: OWNER
Credential: D.O.
Phone: 425-820-2020