Grudem, Brian Dwight

Grudem, Brian Dwight is an individual health care provider with primary practice located at 4720 White Bear Pkwy , White Bear Lake MN 55110-3336. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Grudem, Brian Dwight can be contacted via phone (651) 426-2747.

Contact Information

Primary practice address
4720 White Bear Pkwy White Bear Lake MN 55110-3336
Phone: (651) 426-2747
Fax: (651) 426-9838
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X LD1732000 Minnesota

Profile Details

NPI number 1194717298
LBN Legal business name Grudem, Brian Dwight
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2005
Last updated Jul 8th, 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 1194717298 NPPES
Minnesota Other P00124841 MEDICARE RAILROAD RETIREM
Minnesota Other 965400656001 MEDICARE RAILROAD RETIREM
Minnesota Other 0N456GR MEDICARE RAILROAD RETIREM
Minnesota Other HP29577 MEDICARE RAILROAD RETIREM
Minnesota Other 22-02690 MEDICARE RAILROAD RETIREM
Minnesota Other 22-02779 MEDICARE RAILROAD RETIREM

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