Bonnie G Bradley, OD
Individual provider Active NPI Optometrist · East Ellijay, GA
NPI 1366446338 · NPPES record last updated Dec 5, 2024
Key facts
- NPI
- 1366446338
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT001314 (GA)
- Practice address
- 772 Maddox Dr
Suite 132
East Ellijay, GA 30540-8194 - Phone
- (706) 276-4455
- Fax
- (706) 276-4458
- NPI assigned
- Jun 8, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Myeyedr Optometry of Georgia, LLC
Practice addresses (Care Compare)
4875 Altama Ave
Brunswick, GA 31520-2912
Phone (912) 554-0010
772 Maddox Dr
Suite 132
East Ellijay, GA 30540-8196
Phone (706) 276-4455
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100615000192 | GA | Practitioner - Optometry | 9234269408 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Past | Accepting new patients |
Locations
4875 Altama Ave
Brunswick, GA 31520
Phone (912) 554-0010
217 Riverstone Dr
Canton, GA 30114
Phone (770) 345-5220
911 N 3rd Ave
Chatsworth, GA 30705
Phone (706) 695-4676
772 Maddox Dr
Ste 132
East Ellijay, GA 30540
Phone (706) 276-4455
8614 Westwood Center Dr
Fl 9
Vienna, VA 22182
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT001314 | GA | Yes |
Addresses
Primary practice location
772 Maddox Dr
Suite 132
East Ellijay, GA 30540-8194
Mailing address
8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00514599A | Medicaid | GA |
Other providers in East Ellijay, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.