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General NPI Number Information
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NPI Number | 1669805362
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Entity Type | Organization
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Legal Business Name | BRADLEY OPTOMETRY INC
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 1160 LIVE OAK BLVD
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City | YUBA CITY
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State | CA
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Zip | 95991-3407
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Country | US
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Telephone | 530-673-8440
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Fax | 530-673-0177
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Provider Business Mailing Address
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Address Line | 1160 LIVE OAK BLVD
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City | YUBA CITY
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State | CA
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Zip | 95991-3407
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Country | US
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Telephone | 530-673-8440
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Fax | 530-673-0177
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Authorized Official
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Title or Position | SOLE DIRECTOR
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Name | DAVID BRADLEY
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Credential | O.D,
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Telephone | 530-673-8440
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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 | 7747TG
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License Number State | CA
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