=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902384126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OKEECHOBEE VALUE SPECS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2018
-----------------------------------------------------
Last Update Date | 06/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 S PARROTT AVE
-----------------------------------------------------
City | OKEECHOBEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34974-6180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-357-2250
-----------------------------------------------------
Fax | 863-357-2254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1611 S PARROTT AVE
-----------------------------------------------------
City | OKEECHOBEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34974-6180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-763-3937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. CHARLES BARTELS
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 863-763-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC3776
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------