Bruesch, Richard David

Bruesch, Richard David is an sole proprietor health care provider with primary practice located at 200 12Th St Sw , Forest Lake MN 55025-1482. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Bruesch, Richard David can be contacted via phone (651) 464-9767.

Contact Information

Primary practice address
200 12Th St Sw Forest Lake MN 55025-1482
Phone: (651) 464-9767
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2622 Minnesota

Profile Details

NPI number 1922119486
LBN Legal business name Bruesch, Richard David
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 31st, 2006
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922119486 NPPES
Minnesota Other 5C945BR BC/BS GRP #
Minnesota Other 5C946BR BC/BS GRP #
Minnesota Other BR746478 BC/BS GRP #
Minnesota Other 152233 BC/BS GRP #
Minnesota Other 412481029770 BC/BS GRP #
Minnesota Other 922683 BC/BS GRP #
Minnesota Other 16824 BC/BS GRP #
Minnesota Other 2100260 BC/BS GRP #
Minnesota Other 2201835 BC/BS GRP #
Minnesota Other 49536 BC/BS GRP #

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