Basic Information
| Provider Information | |||||||||
| NPI: | 1730237967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | BRAD | ||||||||
| MiddleName: | EARL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 W 10250 S | ||||||||
| Address2: | |||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840958843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034813937 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 W ANTELOPE DR | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017764426 | ||||||||
| FaxNumber: | 8017764437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 62665099934 | UT | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.