MEDICARE: JOAN BARTOLOTTA O.D.

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407909823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN BARTOLOTTA O.D.

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	:

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	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	03/31/2008

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