Individual
DR. BRAD ANTHONY BAGGARLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
695 W FOOTHILL BLVD, CLAREMONT, CA 91711-3490
(909) 625-7861
(909) 621-0742
Mailing address
695 W FOOTHILL BLVD, CLAREMONT, CA 91711-3490
(909) 625-7861
(909) 621-0742
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9471-T
CA
152WC0802X
Corneal and Contact Management Optometrist
9471-T
CA
152WP0200X
Pediatric Optometrist
9471-T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WOP9471A
MEDICARE PTAN
CA
Enumeration date
01/10/2007
Last updated
04/03/2012
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