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General NPI Number Information
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NPI Number | 1770764920
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Entity Type | Organization
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Legal Business Name | L BRUCE FOSEN OD PA
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 2535 SE 28TH ST
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City | OCALA
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State | FL
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Zip | 34471-6273
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Country | US
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Telephone | 352-208-0091
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Fax |
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Provider Business Mailing Address
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Address Line | 2535 SE 28TH ST
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City | OCALA
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State | FL
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Zip | 34471-6273
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Country | US
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Telephone | 352-208-0091
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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. LLOYD BRUCE FOSEN
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Credential | O D
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Telephone | 352-208-0091
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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 | OPC 887
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License Number State | FL
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