MEDICARE: BRADFORD NEWTON OD

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	046.007441	IL

General Provider Information

NPI Number	:	1518155241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADFORD NEWTON OD

Provider Business Mailing Address
First Line	:	11103 WEST AVE
Second Line	:	STE. 6
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1370
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	3948 W 26TH ST
Second Line	:	STE 102
City	:	CHICAGO
State	:	IL
Zip	:	60623-3740
Country	:	US
Telephone Number	:	773-542-2020
Fax Number	:	773-542-7050

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	05/24/2017

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Directions to “ BRADFORD NEWTON OD” Practice Location

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