Healthcare Provider Details

I. General information

NPI: 1427029628
Provider Name (Legal Business Name): BRUCE T HAIGHT M.D., INC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR STE 551
LA MESA CA
91942-3078
US

IV. Provider business mailing address

100 E CALIFORNIA BLVD
PASADENA CA
91105-3205
US

V. Phone/Fax

Practice location:
  • Phone: 619-465-2020
  • Fax: 619-698-1189
Mailing address:
  • Phone: 800-898-2020
  • Fax: 626-577-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG41117
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG41117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: