Provider Demographics
NPI:1770852147
Name:BRADLEY B. ROUNDS, PC
Entity Type:Organization
Organization Name:BRADLEY B. ROUNDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:ROUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-654-1863
Mailing Address - Street 1:37 E 100 N
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-1700
Mailing Address - Country:US
Mailing Address - Phone:435-654-1863
Mailing Address - Fax:435-657-0739
Practice Address - Street 1:37 E 100 N
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1700
Practice Address - Country:US
Practice Address - Phone:435-654-1863
Practice Address - Fax:435-657-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1137899934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty