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General NPI Number Information
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NPI Number | 1881141562
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Entity Type | Individual
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Provider Name | BRADLEY POWERS O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 470 TOWN CENTER PL STE 5
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City | COLUMBIA
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State | SC
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Zip | 29229-7957
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Country | US
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Telephone | 803-865-3901
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Fax |
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Provider Business Mailing Address
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Address Line | 470 TOWN CENTER PL STE 5
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City | COLUMBIA
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State | SC
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Zip | 29229-7957
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Country | US
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Telephone | 803-865-3901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT.0003269
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD 60701770
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | SC 1967
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP - 100386
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License Number State | ID
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