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General NPI Number Information
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NPI Number | 1326234337
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Entity Type | Organization
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Legal Business Name | DRS. BLUM & BRUCK, O.D. P.A.
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 2963 MANCHESTER RD STE B
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City | MANCHESTER
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State | MD
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Zip | 21102-1853
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Country | US
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Telephone | 410-239-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 2963 MANCHESTER RD STE B
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City | MANCHESTER
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State | MD
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Zip | 21102-1853
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Country | US
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Telephone | 410-239-6700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIAHU BRUCK
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Credential | OD
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Telephone | 410-239-6700
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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 | TAO877
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License Number State | MD
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