Provider Demographics
NPI:1366487548
Name:BARTHOLOMEW, STEVEN B (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:915 HWY 248
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8003
Mailing Address - Country:US
Mailing Address - Phone:417-334-0044
Mailing Address - Fax:417-334-0046
Practice Address - Street 1:915 HWY 248
Practice Address - Street 2:SUITE A
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8003
Practice Address - Country:US
Practice Address - Phone:417-334-0044
Practice Address - Fax:417-334-0046
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005011625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317333508Medicaid
P00226009OtherRAILROAD MEDICARE
431560263083OtherTRICARE
MO258283268Medicare PIN
P00226009OtherRAILROAD MEDICARE
MO258283230Medicare PIN