Provider Demographics
NPI:1508979006
Name:GREIDER, BRADLEY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:GREIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2067 WEST VISTA WAY
Mailing Address - Street 2:STE 120
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6031
Mailing Address - Country:US
Mailing Address - Phone:760-758-2020
Mailing Address - Fax:760-758-1410
Practice Address - Street 1:2067 WEST VISTA WAY
Practice Address - Street 2:STE 120
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-758-2020
Practice Address - Fax:760-758-1410
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG46461207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG46461BMedicare ID - Type Unspecified
A50392Medicare UPIN