Healthcare Provider Details

I. General information

NPI: 1750342192
Provider Name (Legal Business Name): DAVID B BRADLEY OPTOMETRIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HARRELL DR
GARDEN CITY GA
31408-2005
US

IV. Provider business mailing address

22 HARRELL DR
GARDEN CITY GA
31408-2005
US

V. Phone/Fax

Practice location:
  • Phone: 912-964-0483
  • Fax: 912-964-0488
Mailing address:
  • Phone: 912-964-0483
  • Fax: 912-964-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT000730
License Number StateGA

VIII. Authorized Official

Name: DR. DAVID BRADLEY
Title or Position: OWNER
Credential: OPTOMETRIST
Phone: 912-964-0483