Organization
BROOKE BUSH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE BUSH (OPTOMETRIST)
(507) 884-9474
Entity
Organization
Contact information
Practice address
18275 KENRICK AVE, LAKEVILLE, MN 55044-7306
(507) 884-9474
Mailing address
PO BOX 211702, EAGAN, MN 55121-3702
(507) 884-9474
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3123
MN
Other
Enumeration date
06/22/2016
Last updated
06/22/2016
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