Provider Demographics
NPI:1104865252
Name:WOLFFIS, BRUCE RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:RICHARD
Last Name:WOLFFIS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:35184 CENTRAL CITY PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-6215
Mailing Address - Country:US
Mailing Address - Phone:734-427-5200
Mailing Address - Fax:734-427-8136
Practice Address - Street 1:735 JOHN R RD STE 150
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5859
Practice Address - Country:US
Practice Address - Phone:248-577-3659
Practice Address - Fax:248-588-9917
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2020-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIBW002561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT96827Medicare UPIN