Provider Demographics
NPI:1407878267
Name:FAERBER, BRUCE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WILLIAM
Last Name:FAERBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2175 CHAMBLISS AVE
Mailing Address - Street 2:STE B
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311
Mailing Address - Country:US
Mailing Address - Phone:423-473-7200
Mailing Address - Fax:423-473-7808
Practice Address - Street 1:2175 CHAMBLISS AVE NW
Practice Address - Street 2:OCOEE EYE CENTER STE B
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3842
Practice Address - Country:US
Practice Address - Phone:423-473-7200
Practice Address - Fax:423-473-7808
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN021886207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3074908Medicaid
TN3074908Medicaid
TN3074908Medicare ID - Type Unspecified