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General NPI Number Information
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NPI Number | 1073726022
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Entity Type | Organization
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Legal Business Name | BRADSHAW OPTOMETRY
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8829 SHELDON RD STE 150
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City | ELK GROVE
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State | CA
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Zip | 95624-5045
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Country | US
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Telephone | 916-682-5558
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Fax | 916-688-5569
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Provider Business Mailing Address
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Address Line | 8829 SHELDON RD STE 150
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City | ELK GROVE
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State | CA
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Zip | 95624-5045
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Country | US
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Telephone | 916-682-5558
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Fax | 916-688-5569
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. PAUL K KIM
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Credential | O.D.
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Telephone | 916-682-5558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 10618T
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License Number State | CA
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