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NPI Code Detail

MEDICARE: MR. BRUCE E EYER MS

MEDICARE: MR. BRUCE E EYER MS
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
1103TC2200XClinical Child & Adolescent PsychologistPS008059LPA
2103T00000XPsychologistPS008059LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
102216301OTHERPACAPITAL BLUE CROSS
2245271OTHERPAVALUE OPTIONS

General Provider Information

NPI Number : 1740230937
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE E EYER MS
Provider Business Mailing Address
First Line : 1803 OREGON PIKE
Second Line : SAMARITAN COUNSELING CENTER
City : LANCASTER
State : PA
Zip : 17601-6401
Country : US
Telephone Number : 717-560-9969
Fax Number : 717-560-9553
Provider Business Practice Location Address
First Line : 1803 OREGON PIKE
Second Line : SAMARITAN COUNSELING CENTER
City : LANCASTER
State : PA
Zip : 17601-6401
Country : US
Telephone Number : 717-560-9969
Fax Number : 717-560-9553
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 06/07/2013

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