Individual
DR. JONATHAN R BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4837 E RT 36, CENTRAL ILLINOIS VISION CENTER, DECATUR, IL 62521
(217) 864-1362
(217) 864-1363
Mailing address
4837 E RTE 36, CENTRAL ILLINOIS VISION CENTER, DECATUR, IL 62521-9725
(217) 864-1362
(217) 864-1363
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010255
IL
152W00000X
Optometrist
18003512A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200904330
—
IN
Enumeration date
06/25/2008
Last updated
12/07/2012
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