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BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES INC OPTOMETRY DIVISION NPI 1316121775


NPI Information

NPI: 1316121775
Provider Name: BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC OPTOMETRY DIVISION

Doing Business As: SIGNATURE MEDICAL GROUP

Classification: Optometrist - 152W00000X
Entity Type: Organization

CLIA Number: 22D2015058

Address:
110 LIBERTY ST
BROCKTON, MA
ZIP 02301
Phone: (508) 894-0400
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BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC OPTOMETRY DIVISION is an optometrist in Brockton, MA. The provider is doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC OPTOMETRY DIVISION NPI is 1316121775. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Signature Medical Group.

The provider's business location address is:

110 LIBERTY ST
BROCKTON, MA
ZIP 02301-521
Phone: (508) 894-0400
Fax: (508) 565-0157

The provider's authorized official is Kim Hollon .
The authorized official title is Ceo and has the following contact phone number (508) 941-7004.

The CLIA number assigned to this NPI record is 22D2015058 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 12/20/2007 and was last updated on 5/23/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1152W00000XOptometrist3009MASSACHUSETTSYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1110022141EMEDICAIDMASSACHUSETTS
2M20452MEDICARE PINMASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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