Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5660TPA | CA |
NPI | 1003997552 |
---|---|
Provider Name | Bruce Gary Dong |
First Address | San Francisco, CA 94122-2401 |
Second Address | San Francisco, CA 94122-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |