Provider Demographics
NPI:1114594892
Name:CARY, BRADLEY DALE (OD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DALE
Last Name:CARY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W BRDWY BUS PARK CT
Mailing Address - Street 2:STE E
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0106
Mailing Address - Country:US
Mailing Address - Phone:573-446-1600
Mailing Address - Fax:
Practice Address - Street 1:3301 W BROADWAY BUSINESS PARK CT STE E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0106
Practice Address - Country:US
Practice Address - Phone:573-446-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021020081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist