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Individual

MICHAEL JACK BRADLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
6551 HARRIS PKWY, STE 205, FORT WORTH, TX 76132-6103
(817) 370-6118
(817) 370-7118
Mailing address
6551 HARRIS PKWY, STE 205, FORT WORTH, TX 76132-6103
(817) 370-6118
(817) 370-7118

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
R0166
TX

Other

Enumeration date
01/16/2007
Last updated
01/25/2008
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