Provider Demographics
NPI:1811094352
Name:FELIX, BRUCE ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:FELIX
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 1:128 MARTHA STREET
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931
Mailing Address - Country:US
Mailing Address - Phone:814-472-2020
Mailing Address - Fax:
Practice Address - Street 1:300 WAL-MART DRIVE
Practice Address - Street 2:THE VISION CENTER
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931
Practice Address - Country:US
Practice Address - Phone:814-471-0591
Practice Address - Fax:814-471-0593
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE008112T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA40650OtherHIGHMARK BLUE CROSS
PA01787177OtherMEDICAL ASSISTANCE ID
PA4146OtherDAVIS VISION
PAU67673Medicare UPIN
PA01787177OtherMEDICAL ASSISTANCE ID