Provider Demographics
NPI:1598725467
Name:BARTOLAC, THOMAS M (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:BARTOLAC
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 1:8730 NORWIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2745
Mailing Address - Country:US
Mailing Address - Phone:724-864-7777
Mailing Address - Fax:724-864-7779
Practice Address - Street 1:8730 NORWIN AVE
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2745
Practice Address - Country:US
Practice Address - Phone:724-864-7777
Practice Address - Fax:724-864-7779
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA406625OtherHIGHMARK BLUECROSS BLUESH
PA580002452OtherPALMETTO GBA, RAILROAD MEDICARE
PA0017204540001Medicaid
PA406625KN1Medicare PIN
PAT30210Medicare UPIN