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General NPI Number Information
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NPI Number | 1447491592
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Entity Type | Organization
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Legal Business Name | BARTLETT EYE CLINICS, P.C.
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 332 N MICHIGAN ST
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City | SOUTH BEND
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State | IN
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Zip | 46601-1226
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Country | US
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Telephone | 574-232-5955
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Fax |
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Provider Business Mailing Address
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Address Line | 332 N MICHIGAN ST
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City | SOUTH BEND
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State | IN
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Zip | 46601-1226
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Country | US
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Telephone | 574-232-5955
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SANDY M WOODRUFF
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Credential |
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Telephone | 574-232-5955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002552B
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License Number State | IN
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