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General NPI Number Information
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NPI Number | 1558350678
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Entity Type | Organization
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Legal Business Name | BRADLEY W NEUJAHR OD PA
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 14 2ND ST NE
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City | BAGLEY
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State | MN
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Zip | 56621
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Country | US
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Telephone | 218-694-2442
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Fax | 218-694-2446
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Provider Business Mailing Address
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Address Line | PO BOX J 14 2ND ST NE
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City | BAGLEY
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State | MN
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Zip | 56621-1008
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Country | US
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Telephone | 218-694-2442
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Fax | 218-694-2446
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Authorized Official
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Title or Position | CEO OWNER
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Name | DR. BRADLEY WAYNE NEUJAHR
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Credential | OD
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Telephone | 218-694-2442
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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 | 1892
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License Number State | MN
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