Healthcare Provider Details

I. General information

NPI: 1073585352
Provider Name (Legal Business Name): WILLIAM BRUCE LAURIE JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COUNTY ROUTE 64
HORSEHEADS NY
14845-2297
US

IV. Provider business mailing address

214 PROSPECT HILL RD
HORSEHEADS NY
14845-7979
US

V. Phone/Fax

Practice location:
  • Phone: 607-739-5209
  • Fax:
Mailing address:
  • Phone: 303-919-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2051
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV-008818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: