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NPI Code Detail

MEDICARE: DR. BRUCE CHARLES WICK O.D., PH.D

MEDICARE: DR. BRUCE CHARLES WICK O.D., PH.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
1152WV0400XVision Therapy Optometrist4042TGTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14743680001OTHERTXCIGNA GOV SERVICES NUMBER

General Provider Information

NPI Number : 1710975412
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE CHARLES WICK O.D., PH.D
Provider Business Mailing Address
First Line : 13615 BELLAIRE BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77083-1714
Country : US
Telephone Number : 281-933-3446
Fax Number : 281-933-6865
Provider Business Practice Location Address
First Line : 13615 BELLAIRE BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77083-1714
Country : US
Telephone Number : 281-933-3446
Fax Number : 281-933-6865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2005
Last Update Date : 03/07/2008

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