Organization
PAUL C BRUDERER O D P C
Active
Other names
West Valley Vision Source
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL CHRISTIAN BRUDERER (OWNER)
(801) 969-9999
Entity
Organization
Contact information
Practice address
2782 S 5600 W STE 101, WEST VALLEY CITY, UT 84120-5592
(801) 969-9999
(801) 746-1007
Mailing address
2782 S 5600 W STE 101, WEST VALLEY CITY, UT 84120-5592
(801) 969-9999
(801) 746-1007
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4942085-9934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157848
FIRST HEALTH
—
01
—
291777
ALTIUS
—
01
—
49420859901
BLUE CROSS BLUE SHIELD
—
05
—
528558921001
—
UT
01
—
5510561
CCN
—
01
—
7664549
AETNA
—
01
—
788511
DESERET MUTUAL
—
01
—
81648
PEHP
—
01
—
IDX5199969
UNIVERSITY HEALTH CARE
UT
01
—
TPRA08151
MOLINA HEALTHCARE
UT
Enumeration date
08/20/2007
Last updated
02/04/2022
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