Provider Demographics
NPI:1255441341
Name:KOFFLER, BRUCE HARVEY (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HARVEY
Last Name:KOFFLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:120 N EAGLE CREEK DRIVE
Mailing Address - Street 2:STE 431
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-263-4631
Mailing Address - Fax:859-463-5694
Practice Address - Street 1:120 N EAGLE CREEK DRIVE
Practice Address - Street 2:STE 431
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-263-4631
Practice Address - Fax:859-463-5694
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY20329207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64203292Medicaid
KY1013230001Medicare NSC
C65745Medicare UPIN
1360101Medicare PIN