Provider Demographics
NPI:1548460496
Name:BRUCE, RICHARD S (RDO ABOC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:BRUCE
Suffix:
Gender:M
Credentials:RDO ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 CONCORD ST
Mailing Address - Street 2:P.O. BOX 270
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8305
Mailing Address - Country:US
Mailing Address - Phone:508-875-0450
Mailing Address - Fax:508-875-0686
Practice Address - Street 1:181 CONCORD ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8305
Practice Address - Country:US
Practice Address - Phone:508-875-0450
Practice Address - Fax:508-875-0686
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1603156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0371190Medicaid