Organization
JACK BRIDGE, O.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK B BRIDGE O.D. (OWNER/PHYSICIAN)
(513) 523-2020
Entity
Organization
Contact information
Practice address
5225 MORNING SUN RD, SUITE B, OXFORD, OH 45056-8929
(513) 523-2020
(513) 523-1101
Mailing address
5225 MORNING SUN RD, SUITE B, OXFORD, OH 45056-8929
(513) 523-2020
(513) 523-1101
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3062T1243
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0248075
—
OH
Enumeration date
11/02/2007
Last updated
04/18/2012
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