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General NPI Number Information
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NPI Number | 1427241843
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Entity Type | Organization
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Legal Business Name | PAUL C BRUDERER O D P C
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 2782 S 5600 W STE 101
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City | WEST VALLEY CITY
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State | UT
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Zip | 84120-5592
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Country | US
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Telephone | 801-969-9999
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Fax | 801-746-1007
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Provider Business Mailing Address
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Address Line | 2782 S 5600 W STE 101
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City | WEST VALLEY CITY
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State | UT
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Zip | 84120-5592
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Country | US
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Telephone | 801-969-9999
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Fax | 801-746-1007
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Authorized Official
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Title or Position | OWNER
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Name | PAUL CHRISTIAN BRUDERER
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Credential |
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Telephone | 801-969-9999
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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 | 4942085-9934
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License Number State | UT
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