Individual
BRADLEY D MARTINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3300 GODFREY RD, GODFREY, IL 62035
(618) 466-8787
(618) 466-4703
Mailing address
PO BOX 5040, GODFREY, IL 62035
(618) 466-8787
(618) 466-4703
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010101
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010101
—
IL
01
—
P00880071
RAILROAD MEDICARE
IL
Enumeration date
10/09/2008
Last updated
04/25/2011
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