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General NPI Number Information
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NPI Number | 1073667937
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Entity Type | Individual
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Provider Name | BRADLEY W TAYLOR
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/17/2012
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Provider Practice Location Address
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Address Line | 5728 WHITMORE LAKE RD
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City | BRIGHTON
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State | MI
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Zip | 48116-1902
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Country | US
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Telephone | 810-227-2357
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Fax |
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Provider Business Mailing Address
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Address Line | 3621 S STATE ST 700 KMS PLACE
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City | ANN ARBOR
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State | MI
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Zip | 48108
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Country | US
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Telephone | 734-936-2047
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003169
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License Number State | MI
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