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General NPI Number Information
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NPI Number | 1093249435
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Entity Type | Organization
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Legal Business Name | BRADLEY T DOOLEN OD LLC
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 573 BLOOMFIELD AVE
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City | VERONA
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State | NJ
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Zip | 07044-1818
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Country | US
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Telephone | 973-239-4518
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Fax | 973-239-6210
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Provider Business Mailing Address
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Address Line | 573 BLOOMFIELD AVE
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City | VERONA
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State | NJ
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Zip | 07044-1818
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Country | US
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Telephone | 973-239-4518
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Fax | 973-239-6210
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Authorized Official
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Title or Position | PRESIDENT/PROVIDER
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Name | BRADLEY T DOOLEN
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Credential |
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Telephone | 973-239-4518
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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 |
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License Number State | NJ
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