MEDICARE: BARTOLOTTA VISION CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG001205	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1417091612	OTHER	PA	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093952210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARTOLOTTA VISION CARE, LLC

Provider Business Mailing Address
First Line	:	3133 NEW GERMANY RD
Second Line	:	SUITE 61
City	:	EBENSBURG
State	:	PA
Zip	:	15931-4348
Country	:	US
Telephone Number	:	814-472-8010
Fax Number	:	814-472-8293

Provider Business Practice Location Address
First Line	:	3133 NEW GERMANY RD
Second Line	:	SUITE 61
City	:	EBENSBURG
State	:	PA
Zip	:	15931-4348
Country	:	US
Telephone Number	:	814-472-8010
Fax Number	:	814-472-8293

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOAN BARTOLOTTA
Credential	:	O.D.
Telephone Number	:	814-472-8010

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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