Provider Demographics
NPI:1982627543
Name:BARTELDT, RICHARD PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PAUL
Last Name:BARTELDT
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 1:1018 CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-6109
Mailing Address - Country:US
Mailing Address - Phone:937-399-0282
Mailing Address - Fax:937-399-1854
Practice Address - Street 1:1018 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-6109
Practice Address - Country:US
Practice Address - Phone:937-399-0282
Practice Address - Fax:937-399-1854
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3386 / T1273152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1982627543OtherNPI
OH1982627543OtherNPI
OHBA0611701Medicare ID - Type Unspecified
OH0685420001Medicare NSC