Provider Demographics
NPI:1124182753
Name:BRADSHAW, ARLOGIA MELODY (OD)
Entity Type:Individual
Prefix:DR
First Name:ARLOGIA
Middle Name:MELODY
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3041
Mailing Address - Country:US
Mailing Address - Phone:216-321-9630
Mailing Address - Fax:
Practice Address - Street 1:4141 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3041
Practice Address - Country:US
Practice Address - Phone:216-321-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3776T1005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0611127Medicaid
OH2163219630OtherVISION SERVICE PLAN
OHBR4121461Medicare ID - Type Unspecified