Michael Jack Bradley
Technician/Technologist, Optician in Fort Worth, TX. Individual provider (NPI-1).
NPI number1407907348
StatusActive
Last updated in NPPESJan 25, 2008
Details
- NPI
- 1407907348
- Entity type
- Individual (NPI-1)
- Name
- Michael Jack Bradley
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 16, 2007
- Last updated
- Jan 25, 2008
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | R0166 | TX | Yes |
Practice location
6551 Harris PkwySte 205
Fort Worth, TX 76132-6103
Phone 817-370-6118 · Fax 817-370-7118
Mailing address
6551 Harris PkwySte 205
Fort Worth, TX 76132-6103
Phone 817-370-6118 · Fax 817-370-7118
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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