Basic Information
| Provider Information | |||||||||
| NPI: | 1689650947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTELS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ZACK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 505164 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631505164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178294620 | ||||||||
| FaxNumber: | 4178294316 | ||||||||
| Practice Location | |||||||||
| Address1: | 3231 S NATIONAL AVE | ||||||||
| Address2: | SUITE 165/166 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658077304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178209393 | ||||||||
| FaxNumber: | 4178410181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046009703 | IL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 02305 | IA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2015011922 | MO | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 046009703 | 05 | IL | MEDICAID | 0740183 | 01 | IA | GROUP IA MEDICAID # | OTHER | 1689350947 | 05 | MO | MEDICAID | 977130 | 01 | IL | IL GROUP MEDICARE # | OTHER | 0443796 | 05 | IA | MEDICAID | 26568 | 01 | IA | IA GROUP MEDICARE # | OTHER |