Healthcare Provider Details

I. General information

NPI: 1881512499
Provider Name (Legal Business Name): TIMOTHY BRADSHAW OD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 EASTLAKE PKWY
CHULA VISTA CA
91915-4116
US

IV. Provider business mailing address

1360 EASTLAKE PKWY
CHULA VISTA CA
91915-4116
US

V. Phone/Fax

Practice location:
  • Phone: 619-500-5038
  • Fax: 619-361-7152
Mailing address:
  • Phone: 619-500-5038
  • Fax: 619-361-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY BRADSHAW
Title or Position: OPTOMETRIST
Credential: OD
Phone: 619-500-5038