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General NPI Number Information
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NPI Number | 1053446443
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Entity Type | Organization
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Legal Business Name | BETH BRUENING PC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/04/2017
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Provider Practice Location Address
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Address Line | 101 TOWER ROAD SUITE 300
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City | DAKOTA DUNES
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State | SD
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Zip | 57049
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Country | US
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Telephone | 605-217-4500
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Fax | 605-217-4503
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Provider Business Mailing Address
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Address Line | PO BOX 3566
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City | SIOUX CITY
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State | IA
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Zip | 51102-3566
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Country | US
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Telephone | 605-217-4500
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TERRI SMITH
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Credential |
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Telephone | 605-217-4500
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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 | 650
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28135
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 3577
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License Number State | SD
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