Individual
DR. BRUCE J POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
440 E KING AVE, TULARE, CA 93274-4223
(559) 686-8628
(559) 686-2507
Mailing address
440 E KING AVE, TULARE, CA 93274-4223
(559) 686-8628
(559) 686-2507
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT 4601 TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0678700001
MEDICARE D DMERC (NAS)
CA
01
—
1801077953
MEDICARE NPI GROUP
CA
01
—
94-1670985
VISION SERVICE PLAN
CA
05
—
YYY41591Y
—
CA
Enumeration date
12/29/2006
Last updated
10/24/2008
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