Healthcare Provider Details

I. General information

NPI: 1891008603
Provider Name (Legal Business Name): ASHLEY BRADFORD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 HIGHWAY 80 SUITE #7
HAUGHTON LA
71037-7441
US

IV. Provider business mailing address

4010 HIGHWAY 80
HAUGHTON LA
71037-7441
US

V. Phone/Fax

Practice location:
  • Phone: 318-949-6085
  • Fax: 318-949-6084
Mailing address:
  • Phone: 318-949-6085
  • Fax: 318-949-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1586-619T
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1586-619T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: