Provider Demographics
NPI:1760608327
Name:BIG LAKE EYE CARE LLC
Entity Type:Organization
Organization Name:BIG LAKE EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:BARTELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:863-763-3937
Mailing Address - Street 1:606 N PARROTT AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2646
Mailing Address - Country:US
Mailing Address - Phone:863-763-3937
Mailing Address - Fax:863-763-4917
Practice Address - Street 1:606 N PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972
Practice Address - Country:US
Practice Address - Phone:863-763-3937
Practice Address - Fax:863-763-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620905001Medicaid
FLK5900Medicare PIN
FLV00322Medicare UPIN