Individual
BRADLEY HENRIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1735 N STATE ST, PROVO, UT 84604-1010
(801) 374-1818
Mailing address
1735 N STATE ST, PROVO, UT 84604-1010
(801) 374-1818
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
MD193060
OR
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
Primary
11598920-1205
UT
Other
Enumeration date
08/05/2015
Last updated
07/14/2020
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