Provider Demographics
NPI:1427346295
Name:BRADLEY, ROCKATONIA
Entity type:Individual
Prefix:
First Name:ROCKATONIA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ROCKATONIA
Other - Middle Name:
Other - Last Name:BATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:700 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-0916
Mailing Address - Country:US
Mailing Address - Phone:270-339-6179
Mailing Address - Fax:
Practice Address - Street 1:1523 SADLER RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4467
Practice Address - Country:US
Practice Address - Phone:270-277-2779
Practice Address - Fax:270-277-2779
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1851DT152W00000X
FL5319152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000725449OtherANTHEM
KY7100172600Medicaid
KY000000725449OtherANTHEM
KY4644660001Medicare NSC