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Individual

DIANE BRUCE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
198 SW BROAD ST, JESUP, GA 31545-1101
(912) 530-6000
(912) 530-6044
Mailing address
5250 LAUREL TER, FLOWERY BRANCH, GA 30542-5238

Taxonomy

Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
OPT001278
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
814827714E
GA
Enumeration date
02/15/2007
Last updated
08/10/2010
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