Provider Demographics
NPI:1174260665
Name:BRIDGE EYE CARE OPTICAL
Entity Type:Organization
Organization Name:BRIDGE EYE CARE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIJLALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:347-275-6610
Mailing Address - Street 1:4008 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1118
Mailing Address - Country:US
Mailing Address - Phone:347-275-6610
Mailing Address - Fax:347-679-6273
Practice Address - Street 1:4008 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1118
Practice Address - Country:US
Practice Address - Phone:347-275-6610
Practice Address - Fax:347-679-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier