Provider Demographics
NPI:1578277810
Name:MAGNOLIA EYE CENTER PC
Entity Type:Organization
Organization Name:MAGNOLIA EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-299-8512
Mailing Address - Street 1:3800 ELECTRIC RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4549
Mailing Address - Country:US
Mailing Address - Phone:540-299-8512
Mailing Address - Fax:540-299-8538
Practice Address - Street 1:3800 ELECTRIC RD STE 101
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4549
Practice Address - Country:US
Practice Address - Phone:540-299-8512
Practice Address - Fax:540-299-8538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty