Bradley J Clodfelter OD, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046007766 Issued in IL

Legal business name

BRADLEY J CLODFELTER OD, P.C.

Practice address

3225 W 111TH St
Suite 102
Chicago, IL 60655-2745

Phone

(773) 238-2142

Fax

(773) 238-9461

NPI assigned

Aug 12, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bradley J Clodfelter, O.D., P.C., O.D.

Title

Optometrist

Phone

(773) 238-2142

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304899200000",
    "number": "1104072024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 W 111TH ST",
            "address_2": "SUITE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606552745",
            "telephone_number": "773-238-2142",
            "fax_number": "773-238-9461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 W 111TH ST",
            "address_2": "SUITE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606552745",
            "telephone_number": "773-238-2142",
            "fax_number": "773-238-9461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY J CLODFELTER OD, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-12",
        "last_updated": "2011-05-09",
        "status": "A",
        "authorized_official_last_name": "CLODFELTER, O.D., P.C.",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "773-238-2142",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DN7029",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Louisa Carlisle Bradford, MSW, LCSW
• Julie Bradish
• Amanda Bradke
• Bradley Backhaus DC LLC
• Bradley G Frieswyk BGF Performance Systems
• Bradley Wellness PLLC
• Stephanie G Bradley-Miller, APRN, CNP
• Alisha M Bradley
• Anne Bradley
• Ashley Bradley, DO

• Optometrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.