Individual
DR. BRADLEY ALAN FREDERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
34719 6TH AVE S, FEDERAL WAY, WA 98003-8714
(206) 212-2100
(206) 212-2194
Mailing address
34719 6TH AVE S, FEDERAL WAY, WA 98003-8714
(206) 212-2100
(206) 212-2194
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003074
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0870427
AETNA GROUP PROVIDER NUMB
WA
05
—
2017242
—
WA
05
—
2017259
—
WA
01
—
2187FR
REGENCE BURIEN RYDER #
WA
01
—
410028421
RAILROAD MEDICARE NUMBER
WA
01
—
59460
L&I GROUP NUMBER
WA
01
—
59461
L & I INDIVIDUAL NUMBER
WA
01
—
891451
CRIME VICTIMS GROUP NUMBE
WA
01
—
911628032
BLUE CROSS BILLING ID #
WA
01
—
91162803298002A003
TRICARE & WPS AUBURN #
WA
01
—
91162803298003A003
TRICARE & WPS FEDERAL WAY
WA
01
—
91162803298116A005
TRICARE & WPS BURIEN #
WA
01
—
EV8144
REGENCE GROUP EEC #
WA
01
—
FR5328
REGENCE AUBURN RYDER #
WA
01
—
FR8712
REGENCE FEDERAL WAY RYDER
WA
Enumeration date
08/25/2006
Last updated
01/03/2024
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