Provider Demographics
NPI:1962504464
Name:BRIDGER, PETER H (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:BRIDGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RED COACH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2020
Mailing Address - Country:US
Mailing Address - Phone:978-468-4768
Mailing Address - Fax:978-762-4934
Practice Address - Street 1:37 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2839
Practice Address - Country:US
Practice Address - Phone:978-774-1118
Practice Address - Fax:978-762-4934
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0354554Medicaid
MA0354554Medicaid
MAT83527Medicare UPIN