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Individual

DR. BRADLEY DAVID MIDDAUGH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1537 BRANTLEY RD, UNIT A2, FORT MYERS, FL 33907-3923
(239) 481-7799
Mailing address
1360 E VENICE AVE, VENICE, FL 34285-9066
(941) 480-2135

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC0002377
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
078638100
FL
01
19695W
MEDICARE PTAN
FL
Enumeration date
08/15/2005
Last updated
02/24/2022
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