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General NPI Number Information
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NPI Number | 1689674921
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Entity Type | Individual
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Provider Name | BRUCE I STARK MD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 915 OLD FERN HILL RD BUILDING B SUITE 200
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City | WEST CHESTER
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State | PA
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Zip | 19380-4269
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Country | US
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Telephone | 610-696-1230
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Fax | 610-918-0803
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Provider Business Mailing Address
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Address Line | 915 OLD FERN HILL RD BUILDING B SUITE 200
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City | WEST CHESTER
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State | PA
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Zip | 19380-4269
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Country | US
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Telephone | 610-696-1230
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Fax | 610-918-0803
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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 | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | MD022743E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD022743E
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License Number State | PA
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