Organization
BRADLEY J CLODFELTER OD, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY J CLODFELTER, O.D., P.C. O.D. (OPTOMETRIST)
(773) 238-2142
Entity
Organization
Contact information
Practice address
3225 W 111TH ST, SUITE 102, CHICAGO, IL 60655-2745
(773) 238-2142
(773) 238-9461
Mailing address
3225 W 111TH ST, SUITE 102, CHICAGO, IL 60655-2745
(773) 238-2142
(773) 238-9461
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007766
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN7029
RAILROAD MEDICARE
IL
Enumeration date
08/12/2008
Last updated
05/09/2011
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