Provider Demographics
NPI:1558363861
Name:MELTZER, BRADLEY ROSS (OD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ROSS
Last Name:MELTZER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:271 SMITHTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2041
Mailing Address - Country:US
Mailing Address - Phone:631-588-5100
Mailing Address - Fax:631-588-5185
Practice Address - Street 1:271 SMITHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2041
Practice Address - Country:US
Practice Address - Phone:631-588-5100
Practice Address - Fax:631-588-5185
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT-5780-1152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC1100C0771Medicare PIN