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General NPI Number Information
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NPI Number | 1811224132
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Entity Type | Individual
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Provider Name | JEREMY KYLE BRUEGGEMANN O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 1000 E 41ST ST 406
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City | AUSTIN
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State | TX
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Zip | 78751-4810
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Country | US
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Telephone | 469-693-1426
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Fax | 512-450-0421
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Provider Business Mailing Address
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Address Line | 7316 CAVE HOLW
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City | AUSTIN
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State | TX
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Zip | 78750-8243
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Country | US
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Telephone |
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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 | 7467TG
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License Number State | TX
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