Provider Demographics
NPI:1497266191
Name:BRIDGEWATER OPTOMETRIC CENTER
Entity Type:Organization
Organization Name:BRIDGEWATER OPTOMETRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISADORE
Authorized Official - Middle Name:BROOK
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-685-0794
Mailing Address - Street 1:329 U.S. HWY 202/206
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:908-685-0794
Mailing Address - Fax:908-685-1502
Practice Address - Street 1:329 US HWY 202/206
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807
Practice Address - Country:US
Practice Address - Phone:908-685-0794
Practice Address - Fax:908-685-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty