Provider Demographics
NPI:1770798407
Name:BEARDEN, BRAD D (OD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:D
Last Name:BEARDEN
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 1:4026 SPRINGLAND LN
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-738-8304
Mailing Address - Fax:360-676-4030
Practice Address - Street 1:2222 JAMES ST
Practice Address - Street 2:SUITE, A
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4152
Practice Address - Country:US
Practice Address - Phone:360-676-4030
Practice Address - Fax:360-676-4030
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026573Medicaid
WA8755BEOtherREGENCE
WA0175737OtherL&I
WAAB39313Medicare ID - Type Unspecified
WA2026573Medicaid