Provider Demographics
NPI:1598968869
Name:BRUCE W ANDERSON, P.A.
Entity Type:Organization
Organization Name:BRUCE W ANDERSON, P.A.
Other - Org Name:ANDERSON EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WALFRED
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-961-2020
Mailing Address - Street 1:719 W FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3422
Mailing Address - Country:US
Mailing Address - Phone:813-961-2020
Mailing Address - Fax:813-961-4105
Practice Address - Street 1:719 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3422
Practice Address - Country:US
Practice Address - Phone:813-961-2020
Practice Address - Fax:813-961-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCK6620OtherRAILROAD
FLCK6620OtherRAILROAD
FL0747270001Medicare NSC