Provider Demographics
NPI:1568719185
Name:LAUDICINA, BRAD S (OD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:S
Last Name:LAUDICINA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1241
Mailing Address - Country:US
Mailing Address - Phone:941-756-2020
Mailing Address - Fax:941-756-4486
Practice Address - Street 1:2003 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1241
Practice Address - Country:US
Practice Address - Phone:941-756-2020
Practice Address - Fax:941-756-4486
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4710152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist