Provider Demographics
NPI:1255336467
Name:PIERSON, BRUCE WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WILLIAM
Last Name:PIERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PICKERING STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1242
Mailing Address - Country:US
Mailing Address - Phone:814-849-4602
Mailing Address - Fax:814-849-3633
Practice Address - Street 1:130 PICKERING STREET
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1242
Practice Address - Country:US
Practice Address - Phone:814-849-4602
Practice Address - Fax:814-849-3633
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2012-09-10
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
PAOEG000043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010041200001Medicaid
PA0237660001Medicare NSC
PA0010041200001Medicaid
PA166225Medicare PIN