Provider Demographics
NPI:1124030812
Name:HOWELL, BRUCE WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WAYNE
Last Name:HOWELL
Suffix:
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 1:2200 STATE HIGHWAY 16 S
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-4616
Mailing Address - Country:US
Mailing Address - Phone:940-549-1800
Mailing Address - Fax:940-549-1818
Practice Address - Street 1:2200 STATE HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4616
Practice Address - Country:US
Practice Address - Phone:940-549-1800
Practice Address - Fax:940-549-1818
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06776TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81437QOtherBCBS
TX0571580001OtherDMERC REGIONC
TX176909301Medicaid
TX0571580001OtherDMERC REGIONC
TX81437QOtherBCBS