Provider Demographics
NPI:1194737965
Name:BARTISS, MICHAEL J (MD OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BARTISS
Suffix:
Gender:M
Credentials:MD OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1902 N SANDHILLS BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2347
Mailing Address - Country:US
Mailing Address - Phone:910-692-2020
Mailing Address - Fax:800-308-9356
Practice Address - Street 1:1902 N SANDHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2382
Practice Address - Country:US
Practice Address - Phone:910-692-2020
Practice Address - Fax:800-308-9356
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300025207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A0760OtherMEDCOST
NC8913620Medicaid
012T9OtherBCBS
FHZ000030OtherFIRST CAROLINA CARE
NC8913620Medicaid
SCQ00025Medicaid
NC8913620Medicaid