Individual
DR. JASON L BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
544
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21332
BLUE CROSS BLUE SHIELD
ND
05
—
60504
—
ND
01
—
870544
VISION SERVICES, INC.
ND
Enumeration date
10/10/2006
Last updated
09/21/2016
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