Provider Demographics
NPI:1669472106
Name:BARTLETT, RICK DALE (OD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:DALE
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 1:843 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3222
Mailing Address - Country:US
Mailing Address - Phone:704-878-2660
Mailing Address - Fax:704-873-5360
Practice Address - Street 1:843 N CENTER ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3222
Practice Address - Country:US
Practice Address - Phone:704-878-2660
Practice Address - Fax:704-878-2636
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1039MB0063824152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909038Medicaid
NC0807620001Medicare NSC
NC0807620002Medicare NSC
NC246349AMedicare PIN
NCT64891Medicare UPIN