Provider Demographics
NPI:1164575684
Name:CLARIN, BRUCE JAY (OD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:JAY
Last Name:CLARIN
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 1:8616 S.W. 79 PLACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-761-5303
Mailing Address - Fax:
Practice Address - Street 1:14429 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7924
Practice Address - Country:US
Practice Address - Phone:305-253-2525
Practice Address - Fax:305-235-3174
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001515152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620540200Medicaid
FL19944Medicare ID - Type Unspecified
FL620540200Medicaid