MEDICARE: DR. BRAD DANIEL MASUGA 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	OPC 4222	FL
2	152W00000X	Optometrist	4901004433	MI

General Provider Information

NPI Number	:	1578700670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD DANIEL MASUGA O.D.

Provider Business Mailing Address
First Line	:	5614 NECTAR CV
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-4085
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8210 LAKEWOOD RANCH BLVD STE 101
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-5331
Country	:	US
Telephone Number	:	941-362-2020
Fax Number	:	941-718-4926

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

Provider Enumeration Date	:	01/11/2009
Last Update Date	:	09/03/2025

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