Provider Demographics
NPI:1073585352
Name:LAURIE, WILLIAM BRUCE JR (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRUCE
Last Name:LAURIE
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PROSPECT HILL RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-7979
Mailing Address - Country:US
Mailing Address - Phone:303-919-0914
Mailing Address - Fax:
Practice Address - Street 1:1400 COUNTY ROUTE 64
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2297
Practice Address - Country:US
Practice Address - Phone:607-739-5209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2051152WC0802X
NYTUV-008818152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTUV-008818OtherSTATE LICENSE
COU82967Medicare UPIN