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General NPI Number Information
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NPI Number | 1376422626
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Entity Type | Individual
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Provider Name | PONDJULEE BRUCH LDO, AAS, ABOC, NCLE
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Gender | Female
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Dates
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Enumeration Date | 08/30/2025
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Last Update Date | 08/30/2025
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Provider Practice Location Address
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Address Line | 4980 E SILVER SPRINGS BLVD
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City | OCALA
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State | FL
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Zip | 34470-3268
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Country | US
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Telephone | 352-236-1611
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Fax | 352-236-2378
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Provider Business Mailing Address
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Address Line | 6420 SE 42ND CT
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City | OCALA
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State | FL
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Zip | 34480-7757
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Country | US
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Telephone | 484-560-3565
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO7380
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License Number State | FL
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