Provider Demographics
NPI:1376055012
Name:BRIDGE & TEMPLE INC
Entity Type:Organization
Organization Name:BRIDGE & TEMPLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AZZAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-850-5953
Mailing Address - Street 1:828 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001
Mailing Address - Country:US
Mailing Address - Phone:805-643-5687
Mailing Address - Fax:805-643-4175
Practice Address - Street 1:828 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001
Practice Address - Country:US
Practice Address - Phone:805-643-5687
Practice Address - Fax:805-643-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty