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General NPI Number Information
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NPI Number | 1932301025
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Entity Type | Organization
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Legal Business Name | BRADLEY E. HABERMEHL
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 4091 RICHFIELD RD
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City | FLINT
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State | MI
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Zip | 48506-2033
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Country | US
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Telephone | 810-736-6673
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Fax | 810-736-2713
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Provider Business Mailing Address
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Address Line | 4091 RICHFIELD RD
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City | FLINT
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State | MI
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Zip | 48506-2033
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Country | US
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Telephone | 810-736-6673
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Fax | 810-736-2713
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | BRADLEY E HABERMEHL
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Credential | O.D.
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Telephone | 810-736-6673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 4901003225
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License Number State | MI
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