Individual
DR. BRADLEY MART LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
700 WENONAH AVE, PEARISBURG, VA 24134-1638
(540) 921-4116
Mailing address
111 RIDGEWAY DR, PRINCETON, WV 24740-9775
(304) 546-2902
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001654
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810010275
—
WV
Enumeration date
07/06/2007
Last updated
05/25/2011
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