Provider Demographics
NPI:1639276173
Name:NAIR, BRIDGET BRADY (OD)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:BRADY
Last Name:NAIR
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 1:100 COLONY LANE
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650
Mailing Address - Country:US
Mailing Address - Phone:724-537-9258
Mailing Address - Fax:724-537-9271
Practice Address - Street 1:100 COLONY LANE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650
Practice Address - Country:US
Practice Address - Phone:724-537-9258
Practice Address - Fax:724-537-9271
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA21308OtherSPECTERA
PA44125OtherDAVIS VISION
PA01969071Medicaid
PA21308OtherSPECTERA
PA01969071Medicaid