Bradley, Jason L

Bradley, Jason L is an individual health care provider with primary practice located at 207 Main St S , Minot ND 58701-3915. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Bradley, Jason L can be contacted via phone (701) 852-5626.

Contact Information

Primary practice address
207 Main St S Minot ND 58701-3915
Phone: (701) 852-5626
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 544 North Dakota

Profile Details

NPI number 1275621161
LBN Legal business name Bradley, Jason L
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2006
Last updated Sep 21st, 2016 - about 9 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 1275621161 NPPES
North Dakota Other 21332 BLUE CROSS BLUE SHIELD
North Dakota MEDICAID 60504 BLUE CROSS BLUE SHIELD
North Dakota Other 870544 BLUE CROSS BLUE SHIELD

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