Provider Demographics
NPI:1689650947
Name:BARTELS, WILLIAM ZACHERY (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ZACHERY
Last Name:BARTELS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 S KIMBROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4856
Mailing Address - Country:US
Mailing Address - Phone:417-470-3937
Mailing Address - Fax:417-470-3938
Practice Address - Street 1:3041 S KIMBROUGH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4856
Practice Address - Country:US
Practice Address - Phone:417-470-3937
Practice Address - Fax:417-470-3938
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015011922152W00000X, 152W00000X
IL046009703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0740183OtherGROUP IA MEDICAID #
IL977130OtherIL GROUP MEDICARE #
IA0443796Medicaid
MO1689350947Medicaid
IL046009703Medicaid
IA26568OtherIA GROUP MEDICARE #
IA0443796Medicaid
MO1689350947Medicaid
ILK11286Medicare PIN
IA114689Medicare PIN