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General NPI Number Information
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NPI Number | 1033259387
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Entity Type | Individual
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Provider Name | GARY WAYNE BRUNER O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6100 SUNRISE MALL
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-6906
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Country | US
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Telephone | 916-721-1466
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Fax | 916-726-0658
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Provider Business Mailing Address
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Address Line | 1418 PINNACLES ST
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City | DAVIS
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State | CA
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Zip | 95616-6658
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Country | US
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Telephone | 530-759-1266
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8066T
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License Number State | CA
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