Provider Demographics
NPI:1699946004
Name:BRADLEY J. SMITH
Entity type:Organization
Organization Name:BRADLEY J. SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-345-1551
Mailing Address - Street 1:370 E MILLTOWN RD STE B
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1280
Mailing Address - Country:US
Mailing Address - Phone:330-345-1551
Mailing Address - Fax:330-967-0053
Practice Address - Street 1:370 E MILLTOWN RD STE B
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1280
Practice Address - Country:US
Practice Address - Phone:330-345-1551
Practice Address - Fax:330-967-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4806332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4715350001Medicare NSC