Diane Bruce, OD

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

OPT001278 Issued in GA

Practice address

198 SW Broad St
Jesup, GA 31545-1101

Phone

(912) 530-6000

Fax

(912) 530-6044

NPI assigned

Feb 15, 2007

Last updated

Aug 10, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pickens Eye Clinic

  • Corneal and Contact Management Optometrist
  • Jasper, GA
  • NPI 1508900879
  NPD (past)
• Pickens Family Eye Care

  • Corneal and Contact Management Optometrist
  • Jasper, GA
  • NPI 1790931921
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281398400000",
    "number": "1114060308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5250 LAUREL TER",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305425238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "198 SW BROAD ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315451101",
            "telephone_number": "912-530-6000",
            "fax_number": "912-530-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCE",
        "first_name": "DIANE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2010-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "GA",
            "license": "OPT001278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "814827714E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Boyette, FNP
• Brandi J Brown
• Marlin Lavar Brown, ATC
• Melody Dempsey Brown, R.N.
• Tonga Brown
• Lafayette Burks, MD
• Mark D Byron, MD
• Stacey N Cain
• Can DO Physical Therapy Inc
• Candide Physical Therapy, LLC

• Corneal and Contact Management Optometrist in Jesup, GA
• Providers in Jesup, GA by specialty
• Corneal and Contact Management Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.