Bradley Eyecare LLC
Organization Active NPI Optometrist · Yulee, FL
NPI 1972008555 · NPPES record last updated Mar 27, 2018
Key facts
- NPI
- 1972008555
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 5319 (FL)
- Legal business name
- BRADLEY EYECARE LLC
- Practice address
- 463867 State Road 200 Ste 4
Yulee, FL 32097-3605 - Phone
- (904) 277-7779
- NPI assigned
- Mar 27, 2018
- Organization subpart
- No
Authorized official
- Name
- Dr. Rockatonia Bradley, OD
- Title
- Owner
- Phone
- (270) 339-6179
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180510001693 | FL | Part B Supplier - Clinic/Group Practice | 7810251261 |
Receives reassigned benefits from 1 practitioner Practice locations: Fernandina Beach, FL |
National Provider Directory
Locations
1553 S 8th St
Fernandina Beach, FL 32034
Phone (904) 261-5955
463867 State Road 200
Ste 4
Yulee, FL 32097
Phone (904) 277-2779
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 5319 | FL | Yes |
Addresses
Primary practice location
463867 State Road 200 Ste 4
Yulee, FL 32097-3605
Mailing address
463867 State Road 200 Ste 4
Yulee, FL 32097-3605
Phone (904) 277-7779
Other practice location 1
1523 Sadler Rd
Fernandina Beach, FL 32034-4467
Phone (904) 261-5955
Other providers in Yulee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2018. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.