Provider Demographics
NPI:1104938281
Name:ANDERSON, BRUCE ANTHONY (OD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ANTHONY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 S 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5870
Mailing Address - Country:US
Mailing Address - Phone:308-760-3184
Mailing Address - Fax:
Practice Address - Street 1:6400 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2351
Practice Address - Country:US
Practice Address - Phone:702-465-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE967152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE76025834700Medicaid
0341800001OtherCGLIC CIGNA
410019713OtherRAILROAD MEDICARE
NE76025834700Medicaid
0341800001Medicare NSC
0341800001OtherCGLIC CIGNA