Provider Demographics
NPI:1649470618
Name:FORSTROM, BRIDGET SUE (OD)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:SUE
Last Name:FORSTROM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BRIDGET
Other - Middle Name:SUE
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2729 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5653
Mailing Address - Country:US
Mailing Address - Phone:312-909-0018
Mailing Address - Fax:
Practice Address - Street 1:302 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-1724
Practice Address - Country:US
Practice Address - Phone:507-375-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist