MEDICARE: DR. BRADLEY T DOOLEN 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	OA005177	NJ

General Provider Information

NPI Number	:	1720164189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY T DOOLEN O.D.

Provider Business Mailing Address
First Line	:	573 BLOOMFIELD AVE
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-1818
Country	:	US
Telephone Number	:	201-207-6240
Fax Number	:	201-207-6240

Provider Business Practice Location Address
First Line	:	573 BLOOMFIELD AVE
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-1818
Country	:	US
Telephone Number	:	201-207-6240
Fax Number	:	201-207-6240

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

Provider Enumeration Date	:	10/28/2006
Last Update Date	:	01/23/2013

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