Provider Demographics
NPI:1861580342
Name:BARTHOLOMEW, LORI (OD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BARTHOLOMEW
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 1:418 ROUTE 23
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07416-2120
Mailing Address - Country:US
Mailing Address - Phone:973-827-4120
Mailing Address - Fax:973-827-0782
Practice Address - Street 1:418 ROUTE 23
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NJ
Practice Address - Zip Code:07416-2120
Practice Address - Country:US
Practice Address - Phone:973-827-4120
Practice Address - Fax:973-827-0782
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00594100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22340OtherNVA
NJ270824079OtherQUALCARE
NJ7662614OtherAETNA
NJP3409568OtherOXFORD
NJ7662614OtherAETNA
NJP3409568OtherOXFORD