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General NPI Number Information
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NPI Number | 1760608327
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Entity Type | Organization
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Legal Business Name | BIG LAKE EYE CARE LLC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 606 N PARROTT AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34972
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Country | US
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Telephone | 863-763-3937
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Fax | 863-763-4917
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Provider Business Mailing Address
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Address Line | 606 N PARROTT AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34972-2646
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Country | US
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Telephone | 863-763-3937
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Fax | 863-763-4917
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. CHARLES WESLEY BARTELS
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Credential | O.D.
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Telephone | 863-763-3937
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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 | OPC3776
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License Number State | FL
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