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Individual
ROCKATONIA BRADLEY
Active
Individual
ROCKATONIA BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1851DT
KY
152W00000X
Optometrist
Primary
5319
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000725449
ANTHEM
KY
05
—
7100172600
—
KY
Enumeration date
07/14/2011
Last updated
07/21/2022
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