Provider Demographics
NPI:1144243296
Name:RABITSCH, BRIGETTE BAILEY (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIGETTE
Middle Name:BAILEY
Last Name:RABITSCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BRIGETTE
Other - Middle Name:A
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4386
Mailing Address - Country:US
Mailing Address - Phone:770-995-5408
Mailing Address - Fax:770-513-2042
Practice Address - Street 1:771 OLD NORCROSS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4979
Practice Address - Country:US
Practice Address - Phone:770-995-5408
Practice Address - Fax:770-513-2042
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00340944OtherRAILROAD MEDICARE
GA41ZCFVZMedicare ID - Type UnspecifiedHAMILTON MILL EYE CARE
GAV05801Medicare UPIN
GA41ZCFVXMedicare ID - Type UnspecifiedCOMMERCE OFFICE LOCATION