Provider Demographics
NPI:1932301025
Name:BRADLEY E. HABERMEHL
Entity Type:Organization
Organization Name:BRADLEY E. HABERMEHL
Other - Org Name:VISION THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HABERMEHL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-736-6673
Mailing Address - Street 1:4091 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2033
Mailing Address - Country:US
Mailing Address - Phone:810-736-6673
Mailing Address - Fax:810-736-2713
Practice Address - Street 1:4091 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2033
Practice Address - Country:US
Practice Address - Phone:810-736-6673
Practice Address - Fax:810-736-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003225152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty