Provider Demographics
NPI:1689227217
Name:DANIEL, BRADLEY ADAM (OD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ADAM
Last Name:DANIEL
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 1:5600 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2023
Mailing Address - Country:US
Mailing Address - Phone:405-943-4413
Mailing Address - Fax:405-942-0115
Practice Address - Street 1:5600 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2023
Practice Address - Country:US
Practice Address - Phone:405-943-4413
Practice Address - Fax:405-942-0115
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist