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NPI Code Detail

MEDICARE: SETH BRUINSMA O.D.

MEDICARE: SETH BRUINSMA O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOD00004151WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10292254OTHERWALABOR & INDUSTRIES
20994BROTHERWAREGENCE
31091BROTHERWAREGENCE
40992BROTHERWAREGENCE
50993BROTHERWAREGENCE
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013116144
Entity Type Code : Individual
Provider Name (Legal Business Name) : SETH BRUINSMA O.D.
Provider Business Mailing Address
First Line : 10002 SE 240TH ST
Second Line :
City : KENT
State : WA
Zip : 98031-4839
Country : US
Telephone Number : 253-852-2020
Fax Number : 253-854-2020
Provider Business Practice Location Address
First Line : 10002 SE 240TH ST
Second Line :
City : KENT
State : WA
Zip : 98031-4839
Country : US
Telephone Number : 253-852-2020
Fax Number : 253-854-2020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2007
Last Update Date : 05/30/2012

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Directions to “ SETH BRUINSMA O.D.” Practice Location

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