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Individual
DR. IVAN BRUCE BANK
Active
Individual
DR. IVAN BRUCE BANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D. ,F.A.A.O.
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
03313TG
TX
152WC0802X
Corneal and Contact Management Optometrist
930-108T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2264B
BLUE CROSS BLUE SHIELD
LA
01
—
721030686BA
HUMANA
LA
01
—
83020
COVENTRY HEALTHCARE
LA
Enumeration date
11/09/2005
Last updated
01/10/2015
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