Provider Demographics
NPI:1215994074
Name:BRADSHAW, MICHAEL ANDREW (OPTICIAN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 W EADS PKWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1171
Mailing Address - Country:US
Mailing Address - Phone:812-537-4733
Mailing Address - Fax:812-537-3934
Practice Address - Street 1:694 W EADS PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1171
Practice Address - Country:US
Practice Address - Phone:812-537-4733
Practice Address - Fax:812-537-3934
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0399460001Medicare NSC