Healthcare Provider Details

I. General information

NPI: 1639631757
Provider Name (Legal Business Name): BRIGETTE LYNN COLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 07/16/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 DAGGETT DR
WEST SPRINGFIELD MA
01089-4667
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 413-286-2020
  • Fax: 503-494-4286
Mailing address:
  • Phone: 503-494-3000
  • Fax: 503-494-4286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1019526
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD215071
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number1019526
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: