Provider Demographics
NPI:1679551444
Name:GIEDD, BRADLEY SCOTT (OD, MS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:GIEDD
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 HOWELL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1013
Mailing Address - Country:US
Mailing Address - Phone:407-671-5445
Mailing Address - Fax:407-671-2899
Practice Address - Street 1:1928 HOWELL BRANCH RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1013
Practice Address - Country:US
Practice Address - Phone:407-671-5445
Practice Address - Fax:407-671-2899
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6205780Medicaid
FL6205780Medicaid
U83233Medicare UPIN