Individual
DR. BRADLEY GEORGE UPSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
671 PARKER AVE, RODEO, CA 94572-1434
(510) 799-4258
(510) 799-6616
Mailing address
671 PARKER AVE, RODEO, CA 94572-1434
(510) 799-4258
(510) 799-6616
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11228T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11228T
STATE OPTOMETRIC LICENSE
CA
05
—
SD0112280
—
CA
Enumeration date
06/25/2006
Last updated
03/07/2023
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