MEDICARE: DR. RICHARD PAUL BARTELDT 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	152WC0802X	Corneal and Contact Management Optometrist	3386 / T1273	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1982627543	OTHER	OH	NPI

General Provider Information

NPI Number	:	1982627543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD PAUL BARTELDT O.D.

Provider Business Mailing Address
First Line	:	1018 CHEYENNE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-6109
Country	:	US
Telephone Number	:	937-399-0282
Fax Number	:	937-399-1854

Provider Business Practice Location Address
First Line	:	1018 CHEYENNE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-6109
Country	:	US
Telephone Number	:	937-399-0282
Fax Number	:	937-399-1854

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	11/10/2008

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