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General NPI Number Information
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NPI Number | 1528659406
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Entity Type | Organization
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Legal Business Name | BARTRAM VISION CARE
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 1185 ST. JOHNS PARKWAY
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City | ST. JOHNS
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State | FL
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Zip | 32259
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Country | US
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Telephone | 205-223-8510
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2552
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32004-2552
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Country | US
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Telephone | 205-223-8510
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CHRISTOPHER KIBICHII MUTAI
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Credential | OD
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Telephone | 205-223-8510
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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 |
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License Number State |
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