Provider Demographics
NPI:1457333064
Name:RICHARDS, BRADLEY W (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 COUNTRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2200
Mailing Address - Country:US
Mailing Address - Phone:801-399-1149
Mailing Address - Fax:801-394-4481
Practice Address - Street 1:875 COUNTRY HILLS DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2200
Practice Address - Country:US
Practice Address - Phone:801-399-1149
Practice Address - Fax:801-394-4481
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1825901205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE36312Medicare UPIN
UT0515900001Medicare NSC