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General NPI Number Information
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NPI Number | 1194706861
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Entity Type | Individual
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Provider Name | IVAN BRUCE BANK O.D. ,F.A.A.O.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 01/10/2015
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Provider Practice Location Address
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Address Line | 8611 HILLCREST AVE STE. 140
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City | DALLAS
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State | TX
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Zip | 75225-4207
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Country | US
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Telephone | 214-739-8611
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Fax | 214-739-8612
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Provider Business Mailing Address
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Address Line | 8611 HILLCREST AVE STE. 140
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City | DALLAS
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State | TX
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Zip | 75225-4207
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Country | US
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Telephone | 214-739-8611
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Fax | 214-739-8612
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 930-108T
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 03313TG
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License Number State | TX
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