Provider Demographics
NPI:1104018860
Name:BRUCE A ANDERSON
Entity Type:Organization
Organization Name:BRUCE A ANDERSON
Other - Org Name:FAMILY VISION CLINIC OF ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-762-4056
Mailing Address - Street 1:PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-0830
Mailing Address - Country:US
Mailing Address - Phone:308-762-4056
Mailing Address - Fax:308-762-4063
Practice Address - Street 1:1317 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3125
Practice Address - Country:US
Practice Address - Phone:308-762-4056
Practice Address - Fax:308-762-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE967152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0341800001Medicare NSC