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General NPI Number Information
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NPI Number | 1235432600
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Entity Type | Organization
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Legal Business Name | BRADSHAW OPTOMETRY CORP
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 3557 BRADSHAW RD STE 2E
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City | SACRAMENTO
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State | CA
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Zip | 95827-3373
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Country | US
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Telephone | 916-361-2020
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Fax | 916-361-0433
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Provider Business Mailing Address
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Address Line | 3557 BRADSHAW RD #2E
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City | SACRAMENTO
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State | CA
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Zip | 95827-3373
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Country | US
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Telephone | 916-361-2020
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Fax | 916-361-0433
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | MRS. PAUL K KIM
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Credential | O.D.
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Telephone | 916-361-2020
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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 | 10618T
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License Number State | CA
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