Provider Demographics
NPI:1427029628
Name:HAIGHT, BRUCE T (MD, INC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:T
Last Name:HAIGHT
Suffix:
Gender:M
Credentials:MD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3205
Mailing Address - Country:US
Mailing Address - Phone:800-898-2020
Mailing Address - Fax:626-577-2100
Practice Address - Street 1:5565 GROSSMONT CENTER DR STE 551
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3078
Practice Address - Country:US
Practice Address - Phone:619-465-2020
Practice Address - Fax:619-698-1189
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41117174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G411170Medicaid
CA00G411170Medicaid
CAA92233Medicare UPIN
CAG41117Medicare ID - Type Unspecified