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NPI Code Detail

MEDICARE: BRADY L WILBORN O.D.

MEDICARE: BRADY L WILBORN O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1608KS
2152W00000XOptometrist168620MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124025879
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADY L WILBORN O.D.
Provider Business Mailing Address
First Line : 202 E NORTH ST
Second Line :
City : CALIFORNIA
State : MO
Zip : 65018-1583
Country : US
Telephone Number : 573-796-2222
Fax Number : 573-796-4184
Provider Business Practice Location Address
First Line : 202 E NORTH ST
Second Line :
City : CALIFORNIA
State : MO
Zip : 65018-1583
Country : US
Telephone Number : 573-796-2222
Fax Number : 573-796-4184
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/19/2007

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Directions to “ BRADY L WILBORN O.D.” Practice Location

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