Dr Richard D Bruesch, PA

NPI #1912115999 in Forest Lake, Minnesota

Provider Information

NPI Number: 1912115999
Entity Type: Organization
Organization Name: Dr Richard D Bruesch, PA
Primary Specialty: Optometrist
Enumeration Date: May 21, 2007
Last Updated: Nov 19, 2012

Practice Location

Address: 200 12TH ST SW
City: Forest Lake
State: Minnesota
ZIP Code: 55025-1482
Phone: (651) 464-9767

Authorized Official

Name: DR. RICHARD D BRUESCH, OD
Title: OPTOMETRIST
Phone: (651) 464-9767

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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