Provider Demographics
NPI:1962651364
Name:BARTELS, AMBER E (OD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:E
Last Name:BARTELS
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 1:1280 N SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4459
Mailing Address - Country:US
Mailing Address - Phone:262-567-3214
Mailing Address - Fax:262-567-2449
Practice Address - Street 1:1280 N SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4459
Practice Address - Country:US
Practice Address - Phone:262-567-3214
Practice Address - Fax:262-567-2449
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT904152W00000X
WI3211-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962651364Medicaid
ME433096599Medicaid
MEOPT904OtherMAINE LICENSE
WI1962651364Medicaid