Provider Demographics
NPI:1689962862
Name:MILLESON, BRIDGETTE ADAIR (OD)
Entity type:Individual
Prefix:DR
First Name:BRIDGETTE
Middle Name:ADAIR
Last Name:MILLESON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:EVAN
Other - Last Name:MILLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4496 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1146
Mailing Address - Country:US
Mailing Address - Phone:405-477-7942
Mailing Address - Fax:
Practice Address - Street 1:220 SOUTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-0643
Practice Address - Country:US
Practice Address - Phone:740-532-2020
Practice Address - Fax:740-532-0176
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6057 T2972152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist