Provider Demographics
NPI:1750333530
Name:CHASE, BRUCE DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DAVID
Last Name:CHASE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:133-135 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2275
Mailing Address - Country:US
Mailing Address - Phone:978-664-6211
Mailing Address - Fax:978-664-3251
Practice Address - Street 1:133-135 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2275
Practice Address - Country:US
Practice Address - Phone:978-664-6211
Practice Address - Fax:978-664-3251
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA152136OtherHARVARD
MA726191OtherTUFTS
MAW15183OtherBCBS
MA152136OtherHARVARD