Provider Demographics
NPI:1225783533
Name:BRUSCO VISION LLC
Entity Type:Organization
Organization Name:BRUSCO VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-921-4567
Mailing Address - Street 1:2302 COBBLE HILL TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-7602
Mailing Address - Country:US
Mailing Address - Phone:201-921-4567
Mailing Address - Fax:
Practice Address - Street 1:3120 FAIRVIEW PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4570
Practice Address - Country:US
Practice Address - Phone:201-921-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty