Healthcare Provider Details

I. General information

NPI: 1619404696
Provider Name (Legal Business Name): BRADLEY RICHLIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8907 WILSHIRE BLVD FL 3
BEVERLY HILLS CA
90211-1930
US

IV. Provider business mailing address

8907 WILSHIRE BLVD FL 3
BEVERLY HILLS CA
90211-1930
US

V. Phone/Fax

Practice location:
  • Phone: 310-276-5333
  • Fax:
Mailing address:
  • Phone: 310-276-5333
  • Fax: 310-276-8830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: