Individual
BRADLEY AARON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
909 E SAN MARNAN DRIVE, WATERLOO, IA 50702-5611
(319) 234-2616
(319) 234-1939
Mailing address
PO BOX 2758, WATERLOO, IA 50704-2758
(319) 234-2616
(319) 234-1939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02255
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0417964
—
IA
01
—
35259
WELLMARK INS PLAN
IA
01
—
421417307H4
JOHN DEERE HEALTH INS PLA
IA
Enumeration date
06/06/2006
Last updated
02/07/2022
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