MEDICARE: JENNIFER G BARTOLOME OPTOMETRY CORP 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	13498	CA
2	152WC0802X	Corneal and Contact Management Optometrist	13498	CA

General Provider Information

NPI Number	:	1669635413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER G BARTOLOME OPTOMETRY CORP O.D.

Provider Business Mailing Address
First Line	:	10977 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3341
Country	:	US
Telephone Number	:	818-763-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	10977 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3341
Country	:	US
Telephone Number	:	818-763-6666
Fax Number	:

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

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/22/2015

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