Individual
MR. BRADLEY PETER BOHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LO
Contact information
Practice address
VISION CENTER, 155 WATERFORD PKWY NORTH, WATERFORD, CT 06385
(860) 437-3748
Mailing address
38 OAK ST, WESTERLY, RI 02891-1741
(401) 596-9482
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
632
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
581910859
TAX ID
CT
Enumeration date
06/19/2009
Last updated
06/19/2009
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