Provider Demographics
NPI:1669727814
Name:BRIDGET B. NAIR O.D.
Entity type:Organization
Organization Name:BRIDGET B. NAIR O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:BRADY
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-537-9258
Mailing Address - Street 1:143 SLATER RD
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-2109
Mailing Address - Country:US
Mailing Address - Phone:724-537-9258
Mailing Address - Fax:
Practice Address - Street 1:100 COLONY LN
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9073
Practice Address - Country:US
Practice Address - Phone:724-537-9258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA803579Medicare PIN
PAU97382Medicare UPIN