Individual
DR. JUSTIN BRADLEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
330 BAKER AVE, CONCORD, MA 01742-2129
(978) 287-9494
(978) 287-9404
Mailing address
330 BAKER AVE, CONCORD, MA 01742-2129
(978) 287-9494
(978) 287-9404
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4654
MA
152WP0200X
Pediatric Optometrist
Primary
4654
MA
152WV0400X
Vision Therapy Optometrist
4654
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0729787
—
MA
Enumeration date
03/08/2008
Last updated
02/26/2021
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