Individual
DR. BRADLEY J LIGHTFOOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
AT2798
OR
152W00000X
Optometrist
Primary
OD00003839
WA
152W00000X
Optometrist
OPTT308
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023294
—
AK
05
—
1144229394
—
OR
05
—
2028348
—
WA
Enumeration date
07/19/2005
Last updated
12/07/2020
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