Provider Demographics
NPI:1063450930
Name:BARTELS, PAT M (OD)
Entity Type:Individual
Prefix:DR
First Name:PAT
Middle Name:M
Last Name:BARTELS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 RUE ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-3601
Mailing Address - Country:US
Mailing Address - Phone:712-323-3401
Mailing Address - Fax:712-256-6713
Practice Address - Street 1:1920 RUE ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3601
Practice Address - Country:US
Practice Address - Phone:712-323-3401
Practice Address - Fax:712-256-6713
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA410039340OtherRAILROAD MEDICARE
IAI17388Medicare UPIN
NE274735Medicare PIN