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General NPI Number Information
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NPI Number | 1104938281
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Entity Type | Individual
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Provider Name | BRUCE ANTHONY ANDERSON OD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 6400 O ST
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City | LINCOLN
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State | NE
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Zip | 68510-2351
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Country | US
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Telephone | 702-465-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 7820 S 28TH ST
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City | LINCOLN
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State | NE
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Zip | 68516-5870
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Country | US
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Telephone | 308-760-3184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 967
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License Number State | NE
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