Provider Demographics
NPI:1710722491
Name:BRADFORD, ANDREW DAY (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAY
Last Name:BRADFORD
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 1:108 MIMOSA RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-7130
Mailing Address - Country:US
Mailing Address - Phone:931-307-4115
Mailing Address - Fax:
Practice Address - Street 1:8141 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9563
Practice Address - Country:US
Practice Address - Phone:256-755-3991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-F37152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist