Organization
BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC OPTOMETRY DIVISION
Active
Other names
Signature Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIM HOLLON (CEO)
(508) 941-7004
Entity
Organization
Contact information
Practice address
110 LIBERTY ST, BROCKTON, MA 02301-5521
(508) 894-0400
(508) 565-0157
Mailing address
110 LIBERTY ST, BROCKTON, MA 02301-5521
(508) 894-0400
(508) 565-0157
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3009
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110022141E
—
MA
Enumeration date
12/20/2007
Last updated
05/23/2012
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