Organization
DR RICHARD D BRUESCH, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD D BRUESCH OD (OPTOMETRIST)
(651) 464-9767
Entity
Organization
Contact information
Practice address
200 12TH ST SW, FOREST LAKE, MN 55025-1482
(651) 464-9767
(651) 464-9062
Mailing address
200 12TH ST SW, FOREST LAKE, MN 55025-1482
(651) 464-9767
(651) 464-9062
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MN2622
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
167933
UCARE
MN
01
—
21000260
MEDICA
MN
01
—
2201835
MEDICA
MN
01
—
412481029770
PREFERREDONE
MN
01
—
5C945BR
BCBS OF MN
MN
01
—
5C946BR
BCBS OF MN
MN
Enumeration date
05/21/2007
Last updated
11/19/2012
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