Sam B Bradley, O.D.
Individual provider Active NPI Optometrist · Fort Smith, AR
NPI 1669445102 · NPPES record last updated Mar 14, 2018
Key facts
- NPI
- 1669445102
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2229 (AR)
- Practice address
- 500 N 6TH St
Fort Smith, AR 72901-2006 - Phone
- (479) 782-7272
- Fax
- (479) 782-7476
- NPI assigned
- Feb 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2229 | AR | Yes |
Addresses
Primary practice location
500 N 6TH St
Fort Smith, AR 72901-2006
Mailing address
500 N 6TH St
Fort Smith, AR 72901-2006
Phone (479) 782-7272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105771722 | Medicaid | AR | |
| 0317710007 | Other | AR | MEDICARE NSC-GREENWOOD CLINIC |
| 100760710A | Medicaid | OK | |
| 48940 | Other | AR | BCBS |
Other providers in Fort Smith, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.