Provider Demographics
NPI:1114072873
Name:SWITALA-BARTLETT, SYLVIA (OD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:
Last Name:SWITALA-BARTLETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 N BOGUS BASIN RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-1548
Mailing Address - Country:US
Mailing Address - Phone:630-699-2374
Mailing Address - Fax:
Practice Address - Street 1:10200 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8900
Practice Address - Country:US
Practice Address - Phone:630-699-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU44196Medicare UPIN
ILL28050Medicare PIN