Provider Demographics
NPI:1598843617
Name:KRIDER, BRADLEY A
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:KRIDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 OSBORNE RD NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2719
Mailing Address - Country:US
Mailing Address - Phone:763-784-3997
Mailing Address - Fax:763-784-3999
Practice Address - Street 1:624 OSBORNE RD NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2719
Practice Address - Country:US
Practice Address - Phone:763-784-3997
Practice Address - Fax:763-784-3999
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician