Individual
DR. BRUCE P MATHIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4865 FRANK AVE NW, NORTH CANTON, OH 44720-7425
(330) 494-1710
(330) 494-5815
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 BLUE CROSS BLUE SH
OH
05
—
2039127
—
OH
01
—
2708610
AETNA
OH
01
—
OH4803
EYEMED
OH
Enumeration date
11/02/2005
Last updated
12/10/2020
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