Individual
BRUCE W. ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
719 W FLETCHER AVE, TAMPA, FL 33612-3422
(813) 961-2020
(813) 961-4105
Mailing address
719 W FLETCHER AVE, TAMPA, FL 33612-3422
(813) 961-2020
(813) 961-4105
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC1520
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078170300
—
FL
01
—
19029
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/25/2006
Last updated
07/01/2021
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