Provider Demographics
NPI:1528659406
Name:BARTRAM VISION CARE
Entity type:Organization
Organization Name:BARTRAM VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KIBICHII
Authorized Official - Last Name:MUTAI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-223-8510
Mailing Address - Street 1:PO BOX 2552
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-2552
Mailing Address - Country:US
Mailing Address - Phone:205-223-8510
Mailing Address - Fax:
Practice Address - Street 1:1185 ST. JOHNS PARKWAY
Practice Address - Street 2:
Practice Address - City:ST. JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:205-223-8510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty