Individual
RICHARD DAVID BRUESCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
200 12TH ST SW, FOREST LAKE, MN 55025-1482
(651) 464-9767
Mailing address
13941 REDWOOD ST NW, ANDOVER, MN 55304-4135
(651) 464-9767
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2622
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
152233
COLE VISION
MN
01
—
16824
SPECTERA
MN
01
—
2100260
MEDICA DISP
MN
01
—
2201835
MEDICA
MN
01
—
412481029770
PREFERREDONE
MN
01
—
49536
DAVIS VISION
MN
01
—
5C945BR
BC/BS GRP #
MN
01
—
5C946BR
BC/BS IND #
MN
01
—
922683
BLOCK VISION
MN
01
—
BR746478
CLARITY VISION
MN
Enumeration date
08/31/2006
Last updated
07/09/2007
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