Provider Demographics
NPI:1407909823
Name:BARTOLOTTA, JOAN (OD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:BARTOLOTTA
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 1:3133 NEW GERMANY RD
Mailing Address - Street 2:SUITE 61
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4348
Mailing Address - Country:US
Mailing Address - Phone:814-472-8010
Mailing Address - Fax:
Practice Address - Street 1:3133 NEW GERMANY RD
Practice Address - Street 2:SUITE 61
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4348
Practice Address - Country:US
Practice Address - Phone:814-472-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015672620002Medicaid
PA1076240002Medicare NSC
PAU18640Medicare UPIN
PA588539Medicare PIN