Provider Demographics
NPI:1700986478
Name:BRADLEY, HELENE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:HELENE
Middle Name:MARIE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 TEN ROD RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-2441
Mailing Address - Country:US
Mailing Address - Phone:401-667-2650
Mailing Address - Fax:401-827-8603
Practice Address - Street 1:1116 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4209
Practice Address - Country:US
Practice Address - Phone:401-828-4838
Practice Address - Fax:401-827-8603
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOD411T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002710Medicaid
RIT79311Medicare UPIN