Freestone, Bradley Dallas
Freestone, Bradley Dallas is an sole proprietor health care provider with primary practice located at 500 Foothill Dr 117Lv, Salt Lake City UT 84148-0001. He recently has 3 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Low Vision Rehabilitation, Eye and Vision Services Providers / Vision Therapy. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Freestone, Bradley Dallas can be contacted via phone (801) 582-1565.Contact Information
Primary practice address
500 Foothill Dr 117Lv
Salt Lake City UT 84148-0001
Phone: (801) 582-1565
Fax: (801) 588-5817
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 6255330-8908 | Utah |
| Eye and Vision Services Providers / Low Vision Rehabilitation | 152WL0500X | 6255330-9934 | Utah |
| Eye and Vision Services Providers / Vision Therapy | 152WV0400X | 6255330-9934 | Utah |
Profile Details
| NPI number | 1134133960 |
|---|---|
| LBN Legal business name | Freestone, Bradley Dallas |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 28th, 2006 |
| Last updated | Jun 25th, 2012 - about 12 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134133960 | NPPES |
| Utah | MEDICAID | D7028 |
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