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General NPI Number Information
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NPI Number | 1639229271
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Entity Type | Individual
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Provider Name | JOSEPH M BAZARTE O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 1611 LISENBY AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-3711
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Country | US
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Telephone | 850-913-0000
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Fax | 850-785-1988
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Provider Business Mailing Address
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Address Line | 1611 LISENBY AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-3711
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Country | US
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Telephone | 850-913-0000
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Fax | 850-785-1988
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC001596
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License Number State | FL
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