Provider Demographics
NPI:1174044499
Name:BRADFORD, CANDICE ANN (OD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:ANN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:ANN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:747 HIGHWAY 71 W STE A-550
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4096
Mailing Address - Country:US
Mailing Address - Phone:512-321-3042
Mailing Address - Fax:
Practice Address - Street 1:747 HIGHWAY 71 W STE A-550
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4096
Practice Address - Country:US
Practice Address - Phone:512-321-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9262T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist