Provider Demographics
NPI:1669635413
Name:BARTOLOME OPTOMETRY CORP, JENNIFER G (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:BARTOLOME OPTOMETRY CORP
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 1:10977 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3341
Mailing Address - Country:US
Mailing Address - Phone:818-763-6666
Mailing Address - Fax:
Practice Address - Street 1:10977 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3341
Practice Address - Country:US
Practice Address - Phone:818-763-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13498152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management