Physician Compare National (NPI:1922119486)

HEALTHCARE PROVIDER: RICHARD DAVID BRUESCH OD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1922119486
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527150911
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070815000052
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BRUESCH
	Individual professional last name
Provider First Name	RICHARD
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1997
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	200 12TH ST SW
	Group Practice or individual's line 1 address
Line 2 Street Address	WAL MART VISION CENTER
	Group Practice or individual's line 2 address
City	FOREST LAKE
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	550251482
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y