Individual
BRADLEY A TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14406 NE 20TH AVE, VANCOUVER, WA 98686-1448
(360) 571-3084
Mailing address
15311 SE BYBEE DR, PORTLAND, OR 97236-7858
(503) 621-6889
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
CERTEFIED
OR
Other
Enumeration date
08/30/2006
Last updated
07/08/2007
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