BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC OPTOMETRY DIVISION (NPI# 1316121775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316121775 |
| Entity Type | Organization |
| Organization Name | BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC OPTOMETRY DIVISION |
| Other Organization Name | SIGNATURE MEDICAL GROUP |
| Practice Address |
110 Liberty St Brockton MA 02301-5521 |
| Practice Telephone | 5088940400 |
| Practice Fax Number | 5085650157 |
| Mailing Telephone | 5088940400 |
| Mailing Fax Number | 5085650157 |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2012-05-23 |
| Authorized Official Name | MR. KIM HOLLON (CEO) |
| Authorized Official Telephone | 5089417004 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 3009 | MA | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110022141E | 05 |
| Other Name | Type Code |
|---|---|
| Signature Medical Group | Doing Business As Name - Organization |
| Street Address |
110 LIBERTY ST |
| City | BROCKTON |
| State | MA |
| Zip Code | 02301-5521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164416186 | Aqeel Siddiqui | Surgery | 110 Liberty St, Brockton, MA 02301-5521 | 2005-09-06 |
| 1902404981 | Sara Louise Borrello | Dietitian, Registered | 110 Liberty St, Brockton, MA 02301-5674 | 2020-10-13 |
| 1134735392 | Meredith Celine Harrington | Physical Medicine & Rehabilitation | 110 Liberty St, Brockton, MA 02301-5674 | 2020-09-22 |
| 1356951784 | Adam S Donahue | Nurse Practitioner | 110 Liberty St, Brockton, MA 02301-5674 | 2020-07-31 |
| 1427603851 | Kristen Laura Barrett | Registered Nurse | 110 Liberty St, Brockton, MA 02301-5674 | 2019-08-02 |
| 1427611722 | Donovan Kelly | Specialist/Technologist | 110 Liberty St, Brockton, MA 02301-5674 | 2019-04-22 |
| 1316411481 | Cassandra Desjardins | Nurse Practitioner | 110 Liberty St, Brockton, MA 02301-5521 | 2019-01-11 |
| 1407353154 | Dean Robert Howell | Social Worker | 110 Liberty St, Brockton, MA 02301-5674 | 2018-04-10 |
| 1619473725 | Patricia L Ramanauskas | Technician/Technologist | 110 Liberty St, Brockton, MA 02301-5521 | 2018-04-05 |
| 1588182323 | Alicia Reid | Specialist/Technologist | 110 Liberty St, Brockton, MA 02301-5521 | 2017-08-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807110 | Jenny Vulpis | Recreation Therapist | 940 Belmont St (br 135), Brockton, MA 02301 | 2020-10-01 |
| 1205444924 | Caroline Storey | Counselor | Men's Addiction Treatment Center, 10 Meadowbrook Road, Brockton, MA 02301 | 2020-07-20 |
| 1013546852 | Nuria Dos Santos Veiga | Occupational Therapist | 73 Denton St, Brockton, MA 02301 | 2020-04-03 |
| 1679113930 | Laura Ann Brondyk II | Counselor | 10 Christys Dr, Brockton, MA 02301 | 2020-01-14 |
| 1437796521 | Andrea Lopes | Developmental Therapist | 7 Goddard Road, Brockton, MA 02301 | 2019-12-08 |
| 1518420124 | Diligencehealthcare | Psychiatry & Neurology | 30-40 Westpark Street, Brockton, MA 02301 | 2019-04-10 |
| 1124530373 | Rachel Theys | Behavioral Analyst | 130 Liberty St Ste 13a, Brockton, MA 02301 | 2017-10-27 |
| 1689193369 | Anderson D Delgado | Behavior Technician | 11 Packard Way, Brockton, MA 02301 | 2017-09-14 |
| 1811415326 | Francesca Lavecchia | Clinical Neuropsychologist | Brockto Area Multi Service, Inc. 10 Christy Dr., Brockton, MA 02301 | 2017-09-05 |
| 1831615343 | Donna Marie Dugan | Counselor | South Bay Community Services, 340 Main Street - Suite 818, Worcester, MA 02301 | 2017-08-16 |
| Find all providers in zip 02301 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| 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. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952423915 | James A Luccio and Associates Inc | Optometrist | 516 Westgate Dr, Brockton, MA 02301-1816 | 2007-04-03 |
| 1780724187 | Robert Peter Kupsc | Optometrist | 21 Torrey St Ste 10, Brockton, MA 02301-4849 | 2007-02-07 |
| 1427126879 | Claire A Bergus | Optometrist | 21 Torrey St, Brockton, MA 02301-4849 | 2006-12-02 |
| 1790853141 | Claire A Bergus | Optometrist | 21 Torrey Street, Brockton, MA 02301 | 2006-12-02 |
| 1689775710 | Bruce Micley | Optometrist | 495 Westgate Dr, Brockton, MA 02301-1833 | 2006-09-25 |
| 1629027941 | Optometric Providers Inc | Optometrist | 726 1/2 Belmont St, Brockton, MA 02301 | 2006-05-06 |
| 1427029875 | William L Olson | Optometrist | 13 West Street, Brockton, MA 02301-3166 | 2006-02-01 |
| 1225653173 | Bryanna Morgan Caron | Optometrist | 940 Belmont St, Brockton, MA 02301-5596 | 2020-06-16 |
| 1649837568 | Jared Koga | Optometrist | 940 Belmont St, Brockton, MA 02301-5596 | 2019-05-27 |
| 1649798620 | Michael Cianca | Optometrist | 63 Main St, Brockton, MA 02301 | 2017-08-30 |
| Find all providers in BROCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.