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NPI Code Detail

MEDICARE: DAVID B BRADLEY OPTOMETRIST PC

MEDICARE: DAVID B BRADLEY OPTOMETRIST PC
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
1152W00000XOptometristOPT000730GA

General Provider Information

NPI Number : 1750342192
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID B BRADLEY OPTOMETRIST PC
Provider Business Mailing Address
First Line : 22 HARRELL DR
Second Line :
City : GARDEN CITY
State : GA
Zip : 31408-2005
Country : US
Telephone Number : 912-964-0483
Fax Number : 912-964-0488
Provider Business Practice Location Address
First Line : 22 HARRELL DR
Second Line :
City : GARDEN CITY
State : GA
Zip : 31408-2005
Country : US
Telephone Number : 912-964-0483
Fax Number : 912-964-0488
Authorized Official
Title or Position : OWNER
Name : DR. DAVID BRADLEY
Credential : OPTOMETRIST
Telephone Number : 912-964-0483
Provider Enumeration Date : 03/28/2006
Last Update Date : 01/25/2008

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Directions to “DAVID B BRADLEY OPTOMETRIST PC ” Practice Location

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