Provider Demographics
NPI:1255775763
Name:BUIE, BERTRAM Z (OD)
Entity type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:Z
Last Name:BUIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1053
Mailing Address - Country:US
Mailing Address - Phone:817-570-0545
Mailing Address - Fax:817-570-0543
Practice Address - Street 1:BUILDING 1880 MILITARY PARKWAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76127-1137
Practice Address - Country:US
Practice Address - Phone:817-570-0545
Practice Address - Fax:817-570-0543
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6525-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist