Provider Demographics
NPI:1538458815
Name:DR. BETHANY H. BRADY AND ASSOCIATES
Entity Type:Organization
Organization Name:DR. BETHANY H. BRADY AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-835-0568
Mailing Address - Street 1:4950 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-5802
Mailing Address - Country:US
Mailing Address - Phone:814-835-0568
Mailing Address - Fax:814-835-0571
Practice Address - Street 1:4950 W 23RD ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-5802
Practice Address - Country:US
Practice Address - Phone:814-835-0568
Practice Address - Fax:814-835-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty