Provider Demographics
NPI:1144419847
Name:BRUCE, JULIE (OD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 W PETERSON AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3306
Mailing Address - Country:US
Mailing Address - Phone:773-588-3090
Mailing Address - Fax:773-588-3210
Practice Address - Street 1:3500 W PETERSON AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3306
Practice Address - Country:US
Practice Address - Phone:773-588-3090
Practice Address - Fax:773-588-3210
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01107047OtherRAILROAD MEDICARE
IL046010027Medicaid
IL0001604768OtherBLUE CROSS BLUE SHEILD
0839990001Medicare NSC
IL7058002Medicare PIN
IL7061002Medicare PIN
IL7060002Medicare PIN
IL7059002Medicare PIN