Provider Demographics
NPI:1568459444
Name:BARTLETT, MATTHEW B (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:B
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 1:810 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2804
Mailing Address - Country:US
Mailing Address - Phone:574-287-3333
Mailing Address - Fax:574-287-9999
Practice Address - Street 1:810 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2804
Practice Address - Country:US
Practice Address - Phone:574-287-3333
Practice Address - Fax:574-287-9999
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002552B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100409990Medicaid
IN260510AMedicare PIN
INU02693Medicare UPIN
IN100409990Medicaid