Jack Bridge, O.D., Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3062T1243 Issued in OH

Legal business name

JACK BRIDGE, O.D., INC.

Practice address

5225 Morning Sun Rd
Suite B
Oxford, OH 45056-8929

Phone

(513) 523-2020

Fax

(513) 523-1101

NPI assigned

Nov 2, 2007

Last updated

Apr 18, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jack B Bridge, O.D.

Title

Owner/Physician

Phone

(513) 523-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1578742912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5225 MORNING SUN RD",
            "address_2": "SUITE B",
            "city": "OXFORD",
            "state": "OH",
            "postal_code": "450568929",
            "telephone_number": "513-523-2020",
            "fax_number": "513-523-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 MORNING SUN RD",
            "address_2": "SUITE B",
            "city": "OXFORD",
            "state": "OH",
            "postal_code": "450568929",
            "telephone_number": "513-523-2020",
            "fax_number": "513-523-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK BRIDGE, O.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-02",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "BRIDGE",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "513-523-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3062T1243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0248075",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Oxford, OH
• Providers in Oxford, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.