Provider Demographics
NPI:1013479229
Name:BRAD HEARN OD PA
Entity Type:Organization
Organization Name:BRAD HEARN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-896-3311
Mailing Address - Street 1:16525 BIRKDALE COMMONS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3803
Mailing Address - Country:US
Mailing Address - Phone:704-896-3311
Mailing Address - Fax:704-896-5514
Practice Address - Street 1:16150 US HIGHWAY 17 N STE A
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-6302
Practice Address - Country:US
Practice Address - Phone:910-270-2800
Practice Address - Fax:910-270-9100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAD HEARN OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909402Medicaid