Provider Demographics
NPI:1780747840
Name:SEPLOWITZ, BRUCE (OD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:SEPLOWITZ
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 1:61 WESTFARMS MALL
Mailing Address - Street 2:D111
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2631
Mailing Address - Country:US
Mailing Address - Phone:860-561-5687
Mailing Address - Fax:
Practice Address - Street 1:61 WESTFARMS MALL
Practice Address - Street 2:D111
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2631
Practice Address - Country:US
Practice Address - Phone:860-561-5687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT859152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22686Medicare UPIN
CT410001004Medicare ID - Type Unspecified