Provider Demographics
NPI:1720273162
Name:BARTLETT MINNICH VISION CENTER
Entity Type:Organization
Organization Name:BARTLETT MINNICH VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:K
Authorized Official - Last Name:VIRGIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-291-9200
Mailing Address - Street 1:332 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1226
Mailing Address - Country:US
Mailing Address - Phone:574-232-5955
Mailing Address - Fax:
Practice Address - Street 1:332 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1226
Practice Address - Country:US
Practice Address - Phone:574-232-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier