Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D6741 | CA |
NPI | 1023220548 |
---|---|
Provider Name | Mr. Eric Martin Bartell |
First Address | Santa Maria, CA 93455-5188 |
Second Address | Santa Maria, CA 93455-5188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |