Provider Demographics
NPI:1891092532
Name:SAUCEDA, BRADLEY
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:SAUCEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11308 BRIARCREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-4628
Mailing Address - Country:US
Mailing Address - Phone:512-825-5060
Mailing Address - Fax:
Practice Address - Street 1:5811 BERKMAN DR
Practice Address - Street 2:SUITE 121
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2666
Practice Address - Country:US
Practice Address - Phone:512-825-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician