MEDICARE: DR. DAVID A. BRADLEY 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
1	152W00000X	Optometrist	7747T	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1275504391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A. BRADLEY O.D.

Provider Business Mailing Address
First Line	:	1160 LIVE OAK BLVD
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-3407
Country	:	US
Telephone Number	:	530-673-8440
Fax Number	:	530-673-0177

Provider Business Practice Location Address
First Line	:	1160 LIVE OAK BLVD
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-3407
Country	:	US
Telephone Number	:	530-673-8440
Fax Number	:	530-673-0177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	04/18/2014

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