Provider Demographics
NPI:1194716100
Name:SENIOR, BRUCE H (DO)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:SENIOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901
Mailing Address - Country:US
Mailing Address - Phone:239-337-2020
Mailing Address - Fax:239-337-7652
Practice Address - Street 1:2277 FIRST STREET
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:239-337-2020
Practice Address - Fax:239-337-7652
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0001000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084290700Medicaid
FL084290700Medicaid
1194716100Medicare PIN
FLT83990Medicare UPIN