Basic Information
| Provider Information | |||||||||
| NPI: | 1093249435 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRADLEY T DOOLEN OD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 573 BLOOMFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | VERONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070441818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732394518 | ||||||||
| FaxNumber: | 9732396210 | ||||||||
| Practice Location | |||||||||
| Address1: | 573 BLOOMFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | VERONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070441818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732394518 | ||||||||
| FaxNumber: | 9732396210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2017 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | DOOLEN | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 9732394518 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | NJ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.