Healthcare Provider Details

I. General information

NPI: 1356392443
Provider Name (Legal Business Name): BRIGID B OGDEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15495 TAMIAMI TRL N SUITE 124
NAPLES FL
34110-6206
US

IV. Provider business mailing address

15495 TAMIAMI TRL N SUITE 124
NAPLES FL
34110-6206
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-4336
  • Fax: 239-593-3019
Mailing address:
  • Phone: 239-596-4336
  • Fax: 239-593-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: