Healthcare Provider Details

I. General information

NPI: 1992649602
Provider Name (Legal Business Name): CHRYSTAL M BRADLEY OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 HWY 9 BYPASS W
LANCASTER SC
29720
US

IV. Provider business mailing address

4062 FLAT CREEK RD
LANCASTER SC
29720-7436
US

V. Phone/Fax

Practice location:
  • Phone: 803-286-4826
  • Fax: 803-286-5938
Mailing address:
  • Phone: 803-286-4826
  • Fax: 803-286-5938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1609
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: