Individual
BRUCE M KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1110 PRAIRIE ST, PRAIRIE DU SAC, WI 53578-2044
(608) 643-3333
(608) 644-3852
Mailing address
1110 PRAIRIE ST, PRAIRIE DU SAC, WI 53578-2044
(608) 643-3333
(608) 644-3852
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1322-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1006588
PHYSICIANS PLUS
WI
05
—
38567400
—
WI
01
—
947
DEAN HEALTH INSURANCE
WI
Enumeration date
05/19/2006
Last updated
04/11/2011
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