MEDICARE: DR. ROY WEBSTER BRUCE JR. 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	OPC001905	FL

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

General Provider Information

NPI Number	:	1932192010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY WEBSTER BRUCE JR. O.D.

Provider Business Mailing Address
First Line	:	1808 JIM REDMAN PKWY
Second Line	:	#117
City	:	PLANT CITY
State	:	FL
Zip	:	33563-6914
Country	:	US
Telephone Number	:	863-608-5330
Fax Number	:

Provider Business Practice Location Address
First Line	:	2602 JIM REDMAN PKWY
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33566-9460
Country	:	US
Telephone Number	:	813-752-5838
Fax Number	:

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	05/11/2015

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