Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1611 | KY |
NPI | 1093159626 |
---|---|
Provider Name | Mr. Adam Charles Bradley |
First Address | Maysville, KY 41056-8956 |
Second Address | Maysville, KY 41056-8956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 25/04/2013 |