Provider Demographics
NPI:1205991338
Name:BARTZ, TAD J (OD)
Entity type:Individual
Prefix:DR
First Name:TAD
Middle Name:J
Last Name:BARTZ
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 1:500 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2847
Mailing Address - Country:US
Mailing Address - Phone:989-773-7747
Mailing Address - Fax:989-779-1068
Practice Address - Street 1:500 S MISSION ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2847
Practice Address - Country:US
Practice Address - Phone:989-773-7747
Practice Address - Fax:989-779-1068
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900B910180OtherBLUE CROSS OF MICHIGAN
MI900B910180OtherBLUE CROSS OF MICHIGAN
MIU66484Medicare UPIN
MION50060Medicare PIN