Provider Demographics
NPI:1912594433
Name:BRIDGEWATER EYE
Entity type:Organization
Organization Name:BRIDGEWATER EYE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RACHED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-375-8529
Mailing Address - Street 1:54 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1748
Mailing Address - Country:US
Mailing Address - Phone:508-697-8001
Mailing Address - Fax:
Practice Address - Street 1:54 BROAD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1748
Practice Address - Country:US
Practice Address - Phone:508-697-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5298OtherOPTOMETRY LICENSE NUMBER