Individual
THADDEUS W BARTLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
271 FARMINGTON AVE, BRISTOL, CT 06010-3901
(860) 582-0702
(860) 314-0263
Mailing address
271 FARMINGTON AVE, BRISTOL, CT 06010-3901
(860) 582-0702
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
790
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004021549
—
CT
01
—
0452540001
MEDICARE DMERC
CT
Enumeration date
08/25/2005
Last updated
08/13/2010
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