Provider Demographics
NPI:1851708846
Name:BUDGE, BRADLEY (OD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BUDGE
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 1:535 E 1400 N STE 130
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2457
Mailing Address - Country:US
Mailing Address - Phone:435-753-5280
Mailing Address - Fax:
Practice Address - Street 1:535 E 1400 N STE 130
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-753-5280
Practice Address - Fax:435-752-5245
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9900923-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist