Koch, Bruce M

Koch, Bruce M is an individual health care provider with primary practice located at 1110 Prairie St , Prairie Du Sac WI 53578-2044. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Koch, Bruce M can be contacted via phone (608) 643-3333.

Contact Information

Primary practice address
1110 Prairie St Prairie Du Sac WI 53578-2044
Phone: (608) 643-3333
Fax: (608) 644-3852
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1322-035 Wisconsin

Profile Details

NPI number 1720031529
LBN Legal business name Koch, Bruce M
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2006
Last updated Apr 11th, 2011 - about 13 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 1720031529 NPPES
Wisconsin MEDICAID 38567400
Wisconsin Other 1006588
Wisconsin Other 947

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