Provider Demographics
NPI:1144332644
Name:DOBSON, BRAD JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:JOSEPH
Last Name:DOBSON
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 1:12400 W HIGHWAY 71 STE 310
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6504
Mailing Address - Country:US
Mailing Address - Phone:512-804-2020
Mailing Address - Fax:512-402-1909
Practice Address - Street 1:12400 W HIGHWAY 71 STE 310
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6504
Practice Address - Country:US
Practice Address - Phone:512-804-2020
Practice Address - Fax:512-402-1909
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6393TG152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4206Medicare PIN
TXU98138Medicare UPIN