Organization
BRAD MORIARTY OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD JEROME MORIARTY OD (PRESIDENT)
(605) 343-4164
Entity
Organization
Contact information
Practice address
1601 MOUNT RUSHMORE RD, SUITE 5, RAPID CITY, SD 57701-4588
(605) 343-4164
(605) 348-9773
Mailing address
1601 MOUNT RUSHMORE RD, SUITE 5, RAPID CITY, SD 57701-4588
(605) 343-4164
(605) 348-9773
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
T484
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9202310
—
SD
01
—
S104430
MEDICARE PTAN
—
Enumeration date
10/26/2010
Last updated
04/27/2012
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