Provider Demographics
NPI:1023289964
Name:GARDNER, BRADLEY WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:GARDNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 LIMESTONE RD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1250
Mailing Address - Country:US
Mailing Address - Phone:302-239-1933
Mailing Address - Fax:302-239-1002
Practice Address - Street 1:5301 LIMESTONE RD
Practice Address - Street 2:SUITE 128
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1250
Practice Address - Country:US
Practice Address - Phone:302-239-1933
Practice Address - Fax:302-239-1002
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist