Individual
BRADFORD D SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
15 WESTERN AVE, SUITE 1, AUGUSTA, ME 04330-7340
(207) 623-2020
(207) 623-1399
Mailing address
15 WESTERN AVE, SUITE 1, AUGUSTA, ME 04330-7340
(207) 623-2020
(207) 623-1399
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT693
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
092002183
FED BC
ME
05
—
115000000
—
ME
01
—
2119511
AETNA
ME
01
—
410019231
RAILROAD MEDICARE
ME
01
—
MNT692
HARVARD PILGRIM
ME
01
—
PR92498370001
CIGNA
ME
Enumeration date
07/31/2006
Last updated
08/14/2008
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