Provider Demographics
NPI:1083138960
Name:TRASK, BRADLEY N (OD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:N
Last Name:TRASK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2652
Mailing Address - Country:US
Mailing Address - Phone:207-945-6200
Mailing Address - Fax:207-990-3015
Practice Address - Street 1:173 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3103
Practice Address - Country:US
Practice Address - Phone:207-764-0376
Practice Address - Fax:207-764-7612
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEOPT989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist