Provider Demographics
NPI:1760224661
Name:GAMACHE, BRADLEY (OD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:GAMACHE
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 1:5141 PATTISON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2039
Mailing Address - Country:US
Mailing Address - Phone:314-313-7849
Mailing Address - Fax:
Practice Address - Street 1:875 RUE SAINT FRANCOIS ST
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-4923
Practice Address - Country:US
Practice Address - Phone:314-839-2400
Practice Address - Fax:314-839-2403
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024019005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist