Provider Demographics
NPI:1083053318
Name:BRIDGES, ERICA LYNNE (OD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LYNNE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:LYNNE
Other - Last Name:STUBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 1201
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4550
Mailing Address - Country:US
Mailing Address - Phone:678-381-2020
Mailing Address - Fax:678-381-2015
Practice Address - Street 1:1034 HAW CREEK CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6513
Practice Address - Country:US
Practice Address - Phone:678-381-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008007-1152W00000X
GAOPT003133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty