Individual
DR. PETER F BRUNGARDT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
436 S OHIO ST, SALINA, KS 67401-3177
(785) 825-0271
(785) 825-0273
Mailing address
436 S OHIO ST, SALINA, KS 67401-3177
(785) 825-0271
(785) 825-0273
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1025-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0185700001
DMERC
KS
01
—
1025-3
OPTOMETRY LICENSE
KS
01
—
650836
BLUE CROSS BLUE SHIELD
KS
Enumeration date
05/31/2005
Last updated
07/08/2007
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