MEDICARE: GREGORY J BRUCHS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3399	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0510790001	OTHER	OH	DMERC
3	2280338	OTHER	OH	UNITED HEALTHCARE
4	000000009496	OTHER	OH	ANTHEM
5	310949280026	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1245234749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY J BRUCHS O.D.

Provider Business Mailing Address
First Line	:	3100 GOVERNORS PLACE BLVD
Second Line	:	STE 100
City	:	KETTERING
State	:	OH
Zip	:	45409-1335
Country	:	US
Telephone Number	:	937-297-7676
Fax Number	:	937-297-7690

Provider Business Practice Location Address
First Line	:	3100 GOVERNORS PLACE BLVD
Second Line	:	STE 100
City	:	KETTERING
State	:	OH
Zip	:	45409-1335
Country	:	US
Telephone Number	:	937-297-7676
Fax Number	:	937-297-7690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/20/2007

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