Provider Demographics
NPI:1992031827
Name:BRUCE R. KING BELL, OD, PC
Entity Type:Organization
Organization Name:BRUCE R. KING BELL, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-684-5650
Mailing Address - Street 1:530 HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-1916
Mailing Address - Country:US
Mailing Address - Phone:770-684-5650
Mailing Address - Fax:770-684-1539
Practice Address - Street 1:530 HUNTER ST
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-1916
Practice Address - Country:US
Practice Address - Phone:770-684-5650
Practice Address - Fax:770-684-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000877152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000217082BMedicaid
GA000217082BMedicaid