Healthcare Provider Details

I. General information

NPI: 1255336467
Provider Name (Legal Business Name): BRUCE WILLIAM PIERSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

130 PICKERING STREET
BROOKVILLE PA
15825-1242
US

IV. Provider business mailing address

130 PICKERING STREET
BROOKVILLE PA
15825-1242
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-4602
  • Fax: 814-849-3633
Mailing address:
  • Phone: 814-849-4602
  • Fax: 814-849-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000043
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: