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General NPI Number Information
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NPI Number | 1750453221
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Entity Type | Organization
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Legal Business Name | DR BRUCE J SPERA OPTOMETRIST A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2296 GALLERIA AT TYLER
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City | RIVERSIDE
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State | CA
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Zip | 92503-4144
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Country | US
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Telephone | 951-689-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 2296 GALLERIA AT TYLER
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City | RIVERSIDE
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State | CA
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Zip | 92503-4144
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Country | US
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Telephone | 951-689-4500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE SPERA
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Credential | O.D.
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Telephone | 951-689-4500
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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 | 6357-T
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License Number State | CA
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