Individual
BRADLEY POLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
8202 37TH AVE, JACKSON HEIGHTS, NY 11372-7023
(718) 478-3539
(718) 205-0963
Mailing address
8202 37TH AVE, JACKSON HEIGHTS, NY 11372-7023
(718) 478-3539
(718) 205-0963
Taxonomy
Speciality
Code
Description
License number
State
156FX1100X
Ophthalmic Technician/Technologist
Primary
006299-2
NY
Other
Enumeration date
10/11/2012
Last updated
10/11/2012
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