Provider Demographics
NPI:1265863831
Name:BRADLEY A WRUBLE OD PLLC
Entity Type:Organization
Organization Name:BRADLEY A WRUBLE OD PLLC
Other - Org Name:BELMONT EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WRUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-860-3510
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-1330
Mailing Address - Country:US
Mailing Address - Phone:704-860-3510
Mailing Address - Fax:
Practice Address - Street 1:2 KENWOOD ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3135
Practice Address - Country:US
Practice Address - Phone:704-860-3510
Practice Address - Fax:704-588-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty