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General NPI Number Information
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NPI Number | 1336515741
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Entity Type | Organization
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Legal Business Name | BRIDGETOWN OPTOMETRIC ASSOCIATES LLC
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 12923 NW CORNELL RD STE 203
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City | PORTLAND
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State | OR
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Zip | 97229-5834
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Country | US
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Telephone | 503-645-5076
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Fax |
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Provider Business Mailing Address
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Address Line | 12923 NW CORNELL RD STE 203
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City | PORTLAND
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State | OR
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Zip | 97229-5834
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Country | US
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Telephone | 503-645-5076
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MICHAEL D OLMA
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Credential | OD
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Telephone | 702-540-1333
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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 | 3577ATI
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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 | 3608ATI
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License Number State | OR
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