DR. BRADLEY MYREN ANDERSON (NPI# 1548258221) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548258221 |
| Entity Type | Individual |
| Full Name | DR. BRADLEY MYREN ANDERSON |
| Credential | MD |
| Practice Address |
2055 15th St N Saint Cloud MN 56303-1747 |
| Practice Telephone | 3202511432 |
| Practice Fax Number | 3202517122 |
| Mailing Telephone | 3202511432 |
| Mailing Fax Number | 3202517122 |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2012-02-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | 43592 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BLUE CROSS | 441T6AN | 01 |
| RAILROAD MEDICARE | P00134021 | 01 | |
| MN | MEDICA | 08-01106 | 01 |
| MN | 527444300 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477016319 | Bradley William Anderson | Student in an Organized Health Care Education/Training Program | 717 S Houston Ave Fl 3, Tulsa, OK 74127-9023 | 2019-04-08 |
| 1912401209 | Bradley Anderson | Dietitian, Registered | 1025 South Trimble Rd., Mansfield, OH 44906 | 2018-03-21 |
| 1790022382 | Bradley Alan Anderson | Chiropractor | 3980 S 700 E Ste 23, Salt Lake City, UT 84107-2530 | 2013-01-15 |
| 1952664260 | Bradley Anderson | Internal Medicine | 1025 E 3300 S Ste B, Salt Lake City, UT 84106 | 2012-06-21 |
| 1174758361 | Bradley Jon Anderson | Dentist | 4521 38th Ave S, Fargo, ND 58104-8507 | 2009-05-18 |
| 1184880635 | Bradley Richard Anderson | Occupational Therapist | 609 Arbor Ct, Highland Village, TX 75077-7569 | 2008-08-04 |
| 1720265820 | Bradley Richard Anderson | Dentist | 11420 W Broad Street, Glen Allen, VA 23060 | 2008-01-31 |
| 1023058757 | Bradley Todd Anderson | Family Medicine | 28622 E 141st St S, Coweta, OK 74429-7515 | 2006-06-08 |
| 1528459633 | Bradley Anderson | Physical Therapist | 75 Minges Creek Pl, Battle Creek, MI 49015-4201 | 2015-02-11 |
| 1356769137 | Bradley Troy Anderson | Pediatrics | 19245 7th Ave Ne, Poulsbo, WA 98370-6551 | 2014-03-31 |
| Street Address |
2055 15TH ST N |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-1747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396733143 | Mitchell Dean Harstad | Optometrist | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-06 |
| 1043650575 | Joel W Nelson | Ophthalmology | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2013-06-28 |
| 1356572804 | Derek John Bonacci | Optometrist | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2009-07-31 |
| 1467499293 | St Cloud Mn Ophthalmology Asc LLC | Clinic/Center | 2055 15th St N, Suite B, Saint Cloud, MN 56303-1747 | 2006-06-01 |
| 1538157805 | St Cloud Eye Clinic Pa | Ophthalmology | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-11 |
| 1376531079 | Steven William Rice | Ophthalmology | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-07 |
| 1083602783 | Richard William Lucius | Ophthalmology | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-07 |
| 1427046267 | St Cloud Opticians | Eyewear Supplier (Equipment, not the service) | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922632066 | St Cloud Eye Center Inc | Ophthalmology | 4589 Henry C Yates Lane, Saint Cloud, FL 34769-3476 | 2020-02-27 |
| 1790228294 | Eye Associates of Central Minnesota Pa | Ophthalmology | 628 Roosevelt Rd, Suite 101, Saint Cloud, MN 56301-4867 | 2016-12-01 |
| 1518352210 | St. Cloud Eye Center, Inc | Ophthalmology | 4589 Henry C Yates Ln, Saint Cloud, FL 34769-6764 | 2015-03-31 |
| 1609814920 | Mark Thomas Moberg | Ophthalmology | 109 Doctors Park, Saint Cloud, MN 56303 | 2006-06-02 |
| 1447298443 | Mitchell Vincent Gossman | Ophthalmology | 628 Roosevelt Rd Ste 101, Saint Cloud, MN 56301-4867 | 2006-06-02 |
| 1922006337 | Jose A Flores Guevara | Ophthalmology | 4589 Henry C. Yates Lane, Saint Cloud, FL 34769 | 2005-07-09 |
| 1043650575 | Joel W Nelson | Ophthalmology | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2013-06-28 |
| 1154352979 | Eye Surgeons & Physicians Pa | Ophthalmology | 109 Doctors Park, Saint Cloud, MN 56303 | 2006-07-06 |
| 1255371175 | James Evan Heeter | Ophthalmology | 109 Doctors Park, Saint Cloud, MN 56303 | 2006-06-08 |
| 1073553996 | Andrea Christine Joplin | Ophthalmology | 628 Roosevelt Rd Ste 101, Saint Cloud, MN 56301-4867 | 2006-06-08 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.