MEDICARE: BARTLETT & SPIVEY PLLC

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	4208-TG	TX

General Provider Information

NPI Number	:	1225309370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARTLETT & SPIVEY PLLC

Provider Business Mailing Address
First Line	:	7125 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1812
Country	:	US
Telephone Number	:	817-232-2321
Fax Number	:

Provider Business Practice Location Address
First Line	:	7125 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1812
Country	:	US
Telephone Number	:	817-232-2321
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. DAVID LAMAR SPIVEY
Credential	:	O.D.
Telephone Number	:	817-232-2321

Provider Enumeration Date	:	01/21/2012
Last Update Date	:	01/21/2012

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