Provider Demographics
NPI:1841875531
Name:DR. BRADLEY P. MUNDY, O.D., PLLC
Entity type:Organization
Organization Name:DR. BRADLEY P. MUNDY, O.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:269-695-3434
Mailing Address - Street 1:400 E FRONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-1403
Mailing Address - Country:US
Mailing Address - Phone:269-695-3434
Mailing Address - Fax:
Practice Address - Street 1:400 E FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107-1403
Practice Address - Country:US
Practice Address - Phone:269-695-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty