Organization
BRUCE W PIERSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE W PIERSON (OWNER)
(814) 849-4602
Entity
Organization
Contact information
Practice address
130 PICKERING ST, BROOKVILLE, PA 15825-0804
(814) 849-4602
Mailing address
130 PICKERING ST, BROOKVILLE, PA 15825-0804
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
OEG000043
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010041200001
—
PA
Enumeration date
05/22/2008
Last updated
05/22/2008
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