Provider Demographics
NPI:1124182225
Name:BESSANT, BRADLEY STEPHEN (OD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:STEPHEN
Last Name:BESSANT
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 1:1410 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3668
Mailing Address - Country:US
Mailing Address - Phone:813-977-7310
Mailing Address - Fax:813-979-4572
Practice Address - Street 1:1410 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3668
Practice Address - Country:US
Practice Address - Phone:813-977-7310
Practice Address - Fax:813-979-4572
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2974152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU52290Medicare UPIN
FL20835Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER