Basham, Bradley S

Basham, Bradley S is an individual health care provider with primary practice located at 1515 E Paulding Rd , Fort Wayne IN 46816-1252. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Basham, Bradley S can be contacted via phone (260) 744-2273.

Contact Information

Primary practice address
1515 E Paulding Rd Fort Wayne IN 46816-1252
Phone: (260) 744-2273
Fax: (260) 744-4555
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 18002201 Indiana

Profile Details

NPI number 1477547628
LBN Legal business name Basham, Bradley S
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 2nd, 2005
Last updated Jun 10th, 2015 - about 10 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 1477547628 NPPES
Indiana MEDICAID 100053350
Indiana MEDICAID 100053350A

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