Doctor Name: | MR. ADAM CHARLES BRADLEY |
NPI Number: | 1093159626 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 1611 |
Business Practice Address: | 1937 Old Main St Suite 2 Maysville, KY - 410568956 |
Business Phone Number: | 6067597311 |
Business Fax Number: | 6067590610 |
Mailing Address: | 1937 Old Main St, Suite 2 MAYSVILLE |
State: | KY |
Postal Code: | 410568956 |
Phone Number: | 6067597311 |
Fax Number: | 6067590610 |
NPI Enumeration Date: | 04/25/2013 |
NPI Last Update Date: | 04/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 1611 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |