Provider Demographics
NPI:1124546882
Name:BRIDGE HILL EYE, LLC
Entity Type:Organization
Organization Name:BRIDGE HILL EYE, LLC
Other - Org Name:BRIDGE HILL, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:COURY
Authorized Official - Last Name:BROBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-533-5336
Mailing Address - Street 1:128 W 13TH ST APT 1416
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2045
Mailing Address - Country:US
Mailing Address - Phone:816-533-5336
Mailing Address - Fax:
Practice Address - Street 1:1221 PENNSYLVANIA AVE APT 2206
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1447
Practice Address - Country:US
Practice Address - Phone:816-533-5336
Practice Address - Fax:816-817-3769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1497130702Medicaid