Provider Demographics
NPI:1578700670
Name:MASUGA, BRAD DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:DANIEL
Last Name:MASUGA
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 1:5614 NECTAR CV
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8120 LAKEWOOD MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5066
Practice Address - Country:US
Practice Address - Phone:941-362-2020
Practice Address - Fax:941-718-4926
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-11
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004433152W00000X
FLOPC 4222152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist