Active NPI
Roy Webster Bruce Jr., O.D.
- Optometrist
- Plant City, FL
National Provider Identifier
1932192010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC001905
- Practice address
- 2602 Jim Redman Pkwy
Plant City, FL 33566-9460 - Phone
- (813) 752-5838
- NPI assigned
- Aug 24, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC001905 | FL | Primary |
Addresses
Primary practice location
2602 Jim Redman Pkwy
Plant City, FL 33566-9460
Mailing address
1808 Jim Redman Pkwy
#117
Plant City, FL 33563-6914
Phone (863) 608-5330
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 078599700 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040107000075 | FL | Practitioner - Optometry | 7214836444 | Practice locations: Plant City, FL |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1905 | FL | MD | Marriage & Family Therapist |
| OPC001905 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431302400000",
"number": "1932192010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1808 JIM REDMAN PKWY",
"address_2": "#117",
"city": "PLANT CITY",
"state": "FL",
"postal_code": "335636914",
"telephone_number": "863-608-5330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2602 JIM REDMAN PKWY",
"city": "PLANT CITY",
"state": "FL",
"postal_code": "335669460",
"telephone_number": "813-752-5838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCE",
"first_name": "ROY",
"middle_name": "WEBSTER",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-24",
"last_updated": "2015-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC001905",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "078599700",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plant City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; 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.