MEDICARE: BRADLEY SAUCEDA

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	156FX1800X	Optician

General Provider Information

NPI Number	:	1891092532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY SAUCEDA

Provider Business Mailing Address
First Line	:	11308 BRIARCREEK LOOP
Second Line	:
City	:	MANOR
State	:	TX
Zip	:	78653-4628
Country	:	US
Telephone Number	:	512-825-5060
Fax Number	:

Provider Business Practice Location Address
First Line	:	5811 BERKMAN DR
Second Line	:	SUITE 121
City	:	AUSTIN
State	:	TX
Zip	:	78723-2666
Country	:	US
Telephone Number	:	512-825-5060
Fax Number	:

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

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	02/15/2011

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Directions to “ BRADLEY SAUCEDA ” Practice Location

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