Healthcare Provider Details

I. General information

NPI: 1447456876
Provider Name (Legal Business Name): BRUCE EYE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W. CALHOUN ST
BRUCE MS
38915-0988
US

IV. Provider business mailing address

PO BOX 988
BRUCE MS
38915-0988
US

V. Phone/Fax

Practice location:
  • Phone: 662-983-2323
  • Fax: 662-983-4126
Mailing address:
  • Phone: 662-983-2323
  • Fax: 662-983-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number577
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number577
License Number StateMS

VIII. Authorized Official

Name: JAMES EDWARD BROWN
Title or Position: OWNER
Credential: OD
Phone: 662-983-2323