Healthcare Provider Details

I. General information

NPI: 1750333530
Provider Name (Legal Business Name): BRUCE DAVID CHASE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133-135 MAIN ST
NORTH READING MA
01864-2275
US

IV. Provider business mailing address

133-135 MAIN ST
NORTH READING MA
01864-2275
US

V. Phone/Fax

Practice location:
  • Phone: 978-664-6211
  • Fax: 978-664-3251
Mailing address:
  • Phone: 978-664-6211
  • Fax: 978-664-3251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2547
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: