Provider Demographics
NPI:1336515741
Name:BRIDGETOWN OPTOMETRIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:BRIDGETOWN OPTOMETRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-540-1333
Mailing Address - Street 1:12923 NW CORNELL RD STE 203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5834
Mailing Address - Country:US
Mailing Address - Phone:503-645-5076
Mailing Address - Fax:
Practice Address - Street 1:12923 NW CORNELL RD STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5834
Practice Address - Country:US
Practice Address - Phone:503-645-5076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3608ATI152W00000X
OR3577ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty