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SIGNATURE MEDICAL GROUP
NPI 1316121775
Optometrist in Brockton, MA

Active since December 20, 2007CLIA 22D2304304 · Waiver
110 LIBERTY ST, BROCKTON, MA 02301(508) 894-0400(508) 565-0157 Get Directions Write a Review

NPPES record last updated: May 23, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Signature Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SIGNATURE MEDICAL GROUP (NPI 1316121775) is a healthcare organization registered as an optometrist in Brockton, Massachusetts and active in the NPI registry since December 2007. The organization holds a CLIA Waiver certificate valid through May 9, 2028 and lists Kim Hollon, Ceo, as its authorized official.

NPPES Registry Identity

NPI1316121775
Entity TypeOrganization
Primary Taxonomy152W00000X
Legal Business NameBRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC OPTOMETRY DIVISION
Location Address110 LIBERTY STBrockton, MA 02301-5521
Mailing Address110 Liberty StBrockton, MA 02301-5521 · (508) 894-0400 · Fax (508) 565-0157
Phone(508) 894-0400
Fax(508) 565-0157
Organization SubpartNo
Authorized OfficialKim HollonCeo · (508) 941-7004
Enumeration DateDecember 20, 2007
Last NPPES UpdateMay 23, 2012
✔ NPI 1316121775 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in MA · 3009
Definition
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.
110 LIBERTY ST, Brockton, MA 02301
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Other Names 1

Doing Business AsSignature Medical Group

Other Identifiers 2

Medicaid110022141EMA
Medicare PINM20452MA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, Blue Cross Blue Shield of Wyoming.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 22D2304304

Signature Medical Group · Brockton, MA
Active · expires May 9, 2028
CLIA Number22D2304304
Laboratory TypePhysician Office
Certificate Effective DateMay 10, 2026
Certificate Expiration DateMay 9, 2028
Laboratory DirectorMark Franciosa
Laboratory Phone(508) 941-7000
Laboratory LocationSignature Medical Group110 Liberty Street, Suite 1C, Brockton, MA 02301
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. RICHARD DUONG PA-C
Physician Assistant
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 565-3055
MRS. RENA B LEVY MSN, FNP-BC
Nurse Practitioner (Family)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
DR. KEVIN RAYMOND GENDREAU M.D.
Family Medicine (Obesity Medicine)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
XIN HE
Internal Medicine (Endocrinology, Diabetes & Metabolism)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
DR. SENA J LEE MD
Dermatology
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 580-1020
NITA MEHTA MD
Ophthalmology
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
DR. TARA SAMANTHA SWIM M.D.
Physical Medicine & Rehabilitation
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 565-3055
NATASHA BITA KHAZAI MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bridgewater Goddard Park Medical Associates, Inc Optometry Division's NPI number?

The NPI number for Bridgewater Goddard Park Medical Associates, Inc Optometry Division is 1316121775. It was assigned to this organization in the NPPES registry on December 20, 2007. The provider is doing business as Signature Medical Group.

Where is Bridgewater Goddard Park Medical Associates, Inc Optometry Division located?

Bridgewater Goddard Park Medical Associates, Inc Optometry Division is located at 110 Liberty St, Brockton, MA 02301. The listed phone number is (508) 894-0400.

What is Bridgewater Goddard Park Medical Associates, Inc Optometry Division's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Does Bridgewater Goddard Park Medical Associates, Inc Optometry Division hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 22D2304304) is associated with this NPI, valid through May 9, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Bridgewater Goddard Park Medical Associates, Inc Optometry Division accept?

Health plans from Blue Cross Blue Shield of Wyoming and Blue Cross and Blue Shield of Louisiana list Bridgewater Goddard Park Medical Associates, Inc Optometry Division as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Bridgewater Goddard Park Medical Associates, Inc Optometry Division was last updated on May 23, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.