Organization
BRUCE P MATHIE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE P MATHIE OD (OWNER)
(330) 875-4320
Entity
Organization
Contact information
Practice address
1403 W MAIN ST, LOUISVILLE, OH 44641-2310
(330) 875-4320
(330) 875-4305
Mailing address
1403 W MAIN ST, LOUISVILLE, OH 44641-2310
(330) 875-4320
(330) 875-4305
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4803
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000223574
ANTHEM
OH
05
—
2039127
—
OH
01
—
2708610
AETNA
OH
01
—
297661819005
MEDICAL MUTUAL
OH
01
—
410048659
RAILRODE MEDICARE
OH
Enumeration date
11/02/2007
Last updated
12/22/2008
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