Provider Demographics
NPI:1336164318
Name:MINGER, BRUCE C
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:C
Last Name:MINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 STATE ROUTE 88 S
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-9140
Mailing Address - Country:US
Mailing Address - Phone:315-331-2647
Mailing Address - Fax:315-331-7917
Practice Address - Street 1:117 E UNION ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1503
Practice Address - Country:US
Practice Address - Phone:315-331-7917
Practice Address - Fax:315-331-7917
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004325156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01782094Medicaid