Provider Demographics
NPI:1891008603
Name:BRADFORD, ASHLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-7441
Mailing Address - Country:US
Mailing Address - Phone:318-949-6085
Mailing Address - Fax:318-949-6084
Practice Address - Street 1:4615 HIGHWAY 80
Practice Address - Street 2:SUITE #7
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-7441
Practice Address - Country:US
Practice Address - Phone:318-949-6085
Practice Address - Fax:318-949-6084
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1586-619T152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management