Smith, Justin Bradley

Smith, Justin Bradley is an individual health care provider with primary practice located at 330 Baker Ave , Concord MA 01742-2129. He recently has 3 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Vision Therapy, Eye and Vision Services Providers / Pediatrics. Eye and Vision Services Providers / Pediatrics is his primary health care specialty. Smith, Justin Bradley can be contacted via phone (978) 287-9494.

Contact Information

Primary practice address
330 Baker Ave Concord MA 01742-2129
Phone: (978) 287-9494
Fax: (978) 287-9404
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 4654 Massachusetts
Eye and Vision Services Providers / Vision Therapy 152WV0400X 4654 Massachusetts
Eye and Vision Services Providers / Pediatrics 152WP0200X 4654 Massachusetts

Profile Details

NPI number 1437329190
LBN Legal business name Smith, Justin Bradley
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 8th, 2008
Last updated Feb 26th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437329190 NPPES
Massachusetts MEDICAID 0729787

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