1811058209 NPI number — DR. RICHARD KENT BARTLETT O.D.

Table of content: DR. RICHARD KENT BARTLETT O.D. (NPI 1811058209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811058209 NPI number — DR. RICHARD KENT BARTLETT O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTLETT
Provider First Name:
RICHARD
Provider Middle Name:
KENT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811058209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76051-5306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-481-2020
Provider Business Mailing Address Fax Number:
817-329-9308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAPEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76051-5306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-481-2020
Provider Business Practice Location Address Fax Number:
817-329-9308
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3116T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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