1447456876 NPI number — BRUCE EYE CLINIC, INC

Table of content: (NPI 1447456876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447456876 NPI number — BRUCE EYE CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUCE EYE CLINIC, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447456876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 988
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUCE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38915-0988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-983-2323
Provider Business Mailing Address Fax Number:
662-983-4126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 W. CALHOUN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUCE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38915-0988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-983-2323
Provider Business Practice Location Address Fax Number:
662-983-4126
Provider Enumeration Date:
06/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
662-983-2323

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  577 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , with the licence number: 577 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)