Organization
PREVENTATIVE & REGENERATIVE EYE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES EDWARD BRUCE O.D. (OPTOMETRIST)
(636) 227-8591
Entity
Organization
Contact information
Practice address
1107 BRITTANY PARKWAY DR, MANCHESTER, MO 63011-4327
(636) 227-8591
Mailing address
1107 BRITTANY PARKWAY DR, MANCHESTER, MO 63011-4327
(636) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO3376
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609868140
—
MO
Enumeration date
11/28/2011
Last updated
11/28/2011
Update your record
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