Provider Demographics
NPI:1558425611
Name:BRADY, JAMES W (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:BRADY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-3902
Mailing Address - Country:US
Mailing Address - Phone:620-343-2335
Mailing Address - Fax:620-343-2337
Practice Address - Street 1:628 COMMERICAL
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801
Practice Address - Country:US
Practice Address - Phone:620-343-2335
Practice Address - Fax:620-343-2337
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician