Healthcare Provider Details

I. General information

NPI: 1528068095
Provider Name (Legal Business Name): BRIDGET HERMANN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HILL RD N
PICKERINGTON OH
43147-9201
US

IV. Provider business mailing address

650 HILL RD N
PICKERINGTON OH
43147-9201
US

V. Phone/Fax

Practice location:
  • Phone: 614-833-2400
  • Fax:
Mailing address:
  • Phone: 614-833-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5476
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: