Provider Demographics
NPI:1316002934
Name:BRUCH EYE CARE ASSOCIATES
Entity Type:Organization
Organization Name:BRUCH EYE CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTITIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-788-4133
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:CONYNGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18219-0752
Mailing Address - Country:US
Mailing Address - Phone:570-788-4133
Mailing Address - Fax:
Practice Address - Street 1:VALLEY PLAZA, RT 93
Practice Address - Street 2:
Practice Address - City:CONYNGHAM
Practice Address - State:PA
Practice Address - Zip Code:18219-0752
Practice Address - Country:US
Practice Address - Phone:570-788-4133
Practice Address - Fax:570-788-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0197820001Medicare ID - Type Unspecified