Provider Demographics
NPI:1801031810
Name:BRADLEY S BESSANT OD PA
Entity Type:Organization
Organization Name:BRADLEY S BESSANT OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BESSANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-681-3863
Mailing Address - Street 1:201 S KINGS AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5712
Mailing Address - Country:US
Mailing Address - Phone:813-681-3863
Mailing Address - Fax:813-681-3077
Practice Address - Street 1:201 S KINGS AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5712
Practice Address - Country:US
Practice Address - Phone:813-681-3863
Practice Address - Fax:813-681-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620351500Medicaid
FL620351500Medicaid
FL20835Medicare PIN