Individual
BRADLEY P BANGSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4220 NW 16TH BLVD, GAINESVILLE, FL 32605-3508
(352) 331-5440
(352) 271-3353
Mailing address
4220 NW 16TH BLVD, GAINESVILLE, FL 32605-3508
(352) 331-5440
(352) 271-3353
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 1898
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
621121600
—
FL
Enumeration date
07/17/2006
Last updated
12/29/2014
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