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General NPI Number Information
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NPI Number | 1477619609
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Entity Type | Organization
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Legal Business Name | BRIDGES OPTICAL
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Dates
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Enumeration Date | 12/30/2006
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3019
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Country | US
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Telephone | 863-682-3226
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Fax | 863-682-1742
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Provider Business Mailing Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3019
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Country | US
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Telephone | 863-682-3226
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Fax | 863-682-1742
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Authorized Official
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Title or Position | OWNER
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Name | MARK BRIDGES
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Credential |
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Telephone | 863-682-3226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1564
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License Number State | FL
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