Provider Demographics
NPI:1902819188
Name:BRUCE EYE CLINIC INC.
Entity Type:Organization
Organization Name:BRUCE EYE CLINIC INC.
Other - Org Name:BRUCE MEDICAL SUPPLY COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:TANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:POTEETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-983-2332
Mailing Address - Street 1:206 WEST CALHOUN STREET
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:MS
Mailing Address - Zip Code:38915-0988
Mailing Address - Country:US
Mailing Address - Phone:662-983-2332
Mailing Address - Fax:662-983-1334
Practice Address - Street 1:206 WEST CALHOUN STREET
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MS
Practice Address - Zip Code:38915-0988
Practice Address - Country:US
Practice Address - Phone:662-983-2332
Practice Address - Fax:662-983-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06321511Medicaid
4772320002Medicare NSC