Backhaus, Bradley L

Backhaus, Bradley L is an individual health care provider with primary practice located at 2404 1St St S Suite 1, Willmar MN 56201-6300. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Backhaus, Bradley L can be contacted via phone (320) 235-1235.

Contact Information

Primary practice address
2404 1St St S Suite 1 Willmar MN 56201-6300
Phone: (320) 235-1235
Fax: (320) 235-9241
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2069 Minnesota

Profile Details

NPI number 1649215476
LBN Legal business name Backhaus, Bradley L
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2006
Last updated Feb 11th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649215476 NPPES
Minnesota MEDICAID 398523700

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