Provider Demographics
NPI:1164430203
Name:BARTLETT, JIMMY D (OD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:D
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:HPB GO80A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0010
Mailing Address - Country:US
Mailing Address - Phone:205-934-4748
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:HPB G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0010
Practice Address - Country:US
Practice Address - Phone:205-975-2020
Practice Address - Fax:205-934-6755
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT-29-TA-008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51059862OtherBLUE CROSS BLUE SHIELD OF
LA1585904Medicaid
MS08304066Medicaid
AL000059862Medicaid
1716A 636005396OtherVISION SERVICES PLAN
ALT69119OtherVIVA HEALTHCARE
LA1585904Medicaid
AL000059477Medicare PIN
AL51059862OtherBLUE CROSS BLUE SHIELD OF
AL000059862Medicaid
AL000059862Medicare PIN