Provider Demographics
NPI:1184799355
Name:HANEY, BRADD D (OD)
Entity type:Individual
Prefix:DR
First Name:BRADD
Middle Name:D
Last Name:HANEY
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 1:1710 COOPER FOSTER PARK RD W
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3680
Mailing Address - Country:US
Mailing Address - Phone:440-989-2020
Mailing Address - Fax:440-282-3300
Practice Address - Street 1:1710 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3680
Practice Address - Country:US
Practice Address - Phone:440-989-2020
Practice Address - Fax:440-282-3300
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4258152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0860831Medicaid
OH0708455Medicare ID - Type Unspecified
OHU26686Medicare UPIN