Provider Demographics
NPI:1336110709
Name:EMDE, BRADFORD MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:MARK
Last Name:EMDE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1000 TUSCULUM BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4056
Mailing Address - Country:US
Mailing Address - Phone:423-639-8128
Mailing Address - Fax:423-798-9204
Practice Address - Street 1:1000 TUSCULUM BLVD
Practice Address - Street 2:STE 4
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4056
Practice Address - Country:US
Practice Address - Phone:423-639-8128
Practice Address - Fax:423-798-9204
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNOD1864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist