=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003015041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHEILA M. BARTLETT A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 08/02/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15908 BEAR VALLEY RD
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92395-9547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-243-4559
-----------------------------------------------------
Fax | 760-243-2052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15908 BEAR VALLEY RD
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92395-9547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-243-4559
-----------------------------------------------------
Fax | 760-243-2052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. SHEILA M BARTLETT
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 760-243-4559
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT4789TPA
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------