Provider Demographics
NPI:1932192010
Name:BRUCE, ROY WEBSTER JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:WEBSTER
Last Name:BRUCE
Suffix:JR
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 1:1808 JIM REDMAN PKWY
Mailing Address - Street 2:#117
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-6914
Mailing Address - Country:US
Mailing Address - Phone:863-608-5330
Mailing Address - Fax:
Practice Address - Street 1:2602 JIM REDMAN PKWY
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-9460
Practice Address - Country:US
Practice Address - Phone:813-752-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078599700Medicaid
FLT93931Medicare UPIN
FL078599700Medicaid