Provider Demographics
NPI:1407898190
Name:UNRUH, BRADLEY A (OD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:UNRUH
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 1:1145 BOWER HILL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1342
Mailing Address - Country:US
Mailing Address - Phone:412-572-6121
Mailing Address - Fax:412-571-1327
Practice Address - Street 1:1145 BOWER HILL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1342
Practice Address - Country:US
Practice Address - Phone:412-572-6121
Practice Address - Fax:412-571-1327
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410037579OtherRAILROAD MEDICARE
PA0017435840001Medicaid
PA1011299OtherHEALTH AMERICA
PA000000118902OtherUNISON HEALTH PLAN
PA117026OtherAETNA
PA410037579OtherRAILROAD MEDICARE
PA1011299OtherHEALTH AMERICA