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General NPI Number Information
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NPI Number | 1265863831
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Entity Type | Organization
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Legal Business Name | BRADLEY A WRUBLE OD PLLC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 2 KENWOOD ST
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City | BELMONT
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State | NC
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Zip | 28012-3135
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Country | US
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Telephone | 704-860-3510
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Fax | 704-588-8761
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Provider Business Mailing Address
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Address Line | PO BOX 1330
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City | BELMONT
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State | NC
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Zip | 28012-1330
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Country | US
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Telephone | 704-860-3510
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. BRADLEY ALAN WRUBLE
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Credential | O.D.
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Telephone | 704-860-3510
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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 | 2181
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License Number State | NC
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