Provider Demographics
NPI:1871289579
Name:MENDOZA, BRADLEY (OD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:MENDOZA
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 1:4439 PAHEE ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2032
Mailing Address - Country:US
Mailing Address - Phone:808-246-0051
Mailing Address - Fax:808-246-4816
Practice Address - Street 1:4439 PAHEE ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2032
Practice Address - Country:US
Practice Address - Phone:808-246-0051
Practice Address - Fax:808-246-4816
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-1004152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist