Individual
DR. CHARLES O BRUCE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 E MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1511
(502) 588-0550
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0330
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
16209
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16209
LICENSE
KY
05
—
300020691
—
IN
05
—
64162092
—
KY
01
—
K267010
MEDICARE
KY
Enumeration date
04/21/2006
Last updated
01/14/2019
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