Provider Demographics
NPI:1750386835
Name:BUNKER, BRUCE WILLIAM (OD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:WILLIAM
Last Name:BUNKER
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 1:19 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2712
Mailing Address - Country:US
Mailing Address - Phone:978-256-5600
Mailing Address - Fax:978-703-0250
Practice Address - Street 1:19 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2712
Practice Address - Country:US
Practice Address - Phone:978-256-5600
Practice Address - Fax:978-703-0250
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0450152W00000X
MA2736152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE5709Medicare ID - Type Unspecified
NH30351004Medicare ID - Type Unspecified
T88910Medicare UPIN