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General NPI Number Information
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NPI Number | 1922000975
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Entity Type | Individual
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Provider Name | BRADLEY JAY SMITH O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 W CLARENDON AVE STE 150
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City | PHOENIX
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State | AZ
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Zip | 85013-3405
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Country | US
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Telephone | 602-265-0343
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Fax | 602-265-2809
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Provider Business Mailing Address
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Address Line | 6002 E HARTFORD AVE
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5902
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Country | US
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Telephone | 602-265-5172
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Fax | 602-265-5171
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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 | 542
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License Number State | AZ
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