Bradley Gardner (NPI# 1255408217, PAC ID# 8921095407) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OPHTHALMOLOGY.
| Nation Provider ID (NPI) | 1255408217 |
| PAC ID by PECOS | 8921095407 |
| Professional Enrollment ID | I20100722000739 |
| Full Name | Bradley Gardner |
| Organization Legal Name | IDAHO EYE CENTER PA |
| Address |
2025 E 17th St Idaho Falls ID 83404-6430 |
| Phone Number | 2085242025 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF CALIFORNIA, CALIFORNIA COLLEGE OF MEDICINE |
| Graduation Year | 1988 |
| Primary Specialty | OPHTHALMOLOGY |
| Group Practice PAC ID | 1557358025 |
| Number of Group Practice Members | 5 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 130018 | EASTERN IDAHO REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 2025 E 17th St, Idaho Falls, ID 83404-6430 | 2085242025 | IDAHO EYE CENTER PA |
| Organization Legal Name | IDAHO EYE CENTER PA |
| Physicians | 5 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| James Davis | Optometry | Idaho Eye Center Pa | 2025 E 17th St, Idaho Falls, ID 83404-6430 |
| Shane L Wynn | Optometry | Idaho Eye Center Pa | 2025 E 17th St, Idaho Falls, ID 83404-6430 |
| Eric K Romriell | Ophthalmology | Idaho Eye Center Pa | 2025 E 17th St, Idaho Falls, ID 83404-6430 |
| Richard Cannon | Ophthalmology | Idaho Eye Center Pa | 2025 E 17th St, Idaho Falls, ID 83404-6430 |
| Street Address |
2025 E 17TH ST |
| City | IDAHO FALLS |
| State | ID |
| Zip | 83404-6430 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| James Davis | Optometry | Idaho Eye Center Pa | 2025 E 17th St, Idaho Falls, ID 83404-6430 |
| Shane L Wynn | Optometry | Idaho Eye Center Pa | 2025 E 17th St, Idaho Falls, ID 83404-6430 |
| Eric K Romriell | Ophthalmology | Idaho Eye Center Pa | 2025 E 17th St, Idaho Falls, ID 83404-6430 |
| Richard Cannon | Ophthalmology | Idaho Eye Center Pa | 2025 E 17th St, Idaho Falls, ID 83404-6430 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Elizabeth Ann Sharp-marsden | Nurse Practitioner | 1680 Elk Creek Dr, Idaho Falls, ID 83404-1225 | |
| Lisa Hong | Occupational Therapy | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Brent Kennedy | Physical Therapy | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Heidi Duran | Physical Therapy | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Rebecca L Butikofer | Occupational Therapy | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Kristan Bullock | Qualified Speech Language Pathologist | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Dawn Taylor | Qualified Speech Language Pathologist | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Brenda Padron | Qualified Speech Language Pathologist | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Kimberly Stowell | Qualified Speech Language Pathologist | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Michael Anderson | Physical Therapy | Foothills Rehabilitation and Performance Services Pllc | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 |
| Find all physicians in zip 83404 | |||
| City | IDAHO FALLS |
| Zip Code | 83404 |
| Specialty | OPHTHALMOLOGY |
| City + Specialty | IDAHO FALLS + OPHTHALMOLOGY |
Please comment or provide details below to improve the information on Bradley Gardner.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.