Provider Demographics
NPI:1164582425
Name:TSAO, BRIDGET J (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:J
Last Name:TSAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 MARICOPA HWY
Mailing Address - Street 2:STE. 101
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023
Mailing Address - Country:US
Mailing Address - Phone:805-646-5109
Mailing Address - Fax:805-646-3519
Practice Address - Street 1:1211 MARICOPA HWY.
Practice Address - Street 2:STE. 101
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023
Practice Address - Country:US
Practice Address - Phone:805-646-5109
Practice Address - Fax:805-646-3519
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7905 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0079050Medicaid
CAT70234Medicare UPIN