Provider Demographics
NPI:1356375463
Name:HABERMEHL, BRADLEY E (OD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:E
Last Name:HABERMEHL
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 1:795 E. SECOND ST.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-706-3899
Mailing Address - Fax:909-469-8640
Practice Address - Street 1:795 E. SECOND ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766
Practice Address - Country:US
Practice Address - Phone:909-706-3899
Practice Address - Fax:909-469-8640
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003225152W00000X
WI3826-35152W00000X
AZOPT-002545152W00000X
CT3191152W00000X
FLTPOP47152W00000X
IN18004441A152W00000X
CA34395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBH003225OtherBCBS OF MI
MIBH003225OtherBCBS OF MI
MIT96852Medicare UPIN