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General NPI Number Information
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NPI Number | 1215135066
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Entity Type | Organization
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Legal Business Name | BRIDGEPORT EYE PHYSICIANS, LLC
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 20015 SW PACIFIC HWY STE 150
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City | SHERWOOD
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State | OR
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Zip | 97140-9316
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Country | US
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Telephone | 503-610-1025
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Fax | 503-610-1596
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Provider Business Mailing Address
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Address Line | 20015 SW PACIFIC HWY STE 150
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City | SHERWOOD
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State | OR
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Zip | 97140-9316
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Country | US
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Telephone | 503-610-1025
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Fax | 503-610-1596
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE W MADSEN
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Credential | MD
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Telephone | 541-971-1514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1670ATI
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD25517
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | DO22937
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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