Provider Demographics
NPI:1952461279
Name:BRADLEY, WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:BRADLEY
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 1:3291 BEL AIR MALL
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3207
Mailing Address - Country:US
Mailing Address - Phone:251-476-2015
Mailing Address - Fax:251-478-5360
Practice Address - Street 1:3291 BEL AIR MALL
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3207
Practice Address - Country:US
Practice Address - Phone:251-476-2015
Practice Address - Fax:251-478-5360
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS405TA267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000026118Medicare ID - Type Unspecified
U25279Medicare UPIN