MEDICARE: BRUCE L BULLION O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901004093	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003814492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE L BULLION O.D.

Provider Business Mailing Address
First Line	:	105 W EXCHANGE ST
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-2024
Country	:	US
Telephone Number	:	616-846-0620
Fax Number	:	616-844-6079

Provider Business Practice Location Address
First Line	:	1960 28TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-7900
Country	:	US
Telephone Number	:	616-247-6677
Fax Number	:	616-247-1254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/25/2007

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