Provider Demographics
NPI:1356551329
Name:ROY BARTLETT DO PS
Entity type:Organization
Organization Name:ROY BARTLETT DO PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:425-820-2020
Mailing Address - Street 1:14050 JUANITA DR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5308
Mailing Address - Country:US
Mailing Address - Phone:425-820-2020
Mailing Address - Fax:
Practice Address - Street 1:14050 JUANITA DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5308
Practice Address - Country:US
Practice Address - Phone:425-820-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003802152W00000X
WAOP00000732207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE72727Medicare UPIN
WAGAB27083Medicare PIN
WA0311470001Medicare NSC