Provider Demographics
NPI:1245234749
Name:BRUCHS, GREGORY J (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:BRUCHS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 GOVERNORS PLACE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1335
Mailing Address - Country:US
Mailing Address - Phone:937-297-7676
Mailing Address - Fax:937-297-7690
Practice Address - Street 1:3100 GOVERNORS PLACE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45409-1335
Practice Address - Country:US
Practice Address - Phone:937-297-7676
Practice Address - Fax:937-297-7690
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0449009Medicaid
OH0510790001OtherDMERC
OH2280338OtherUNITED HEALTHCARE
OH000000009496OtherANTHEM
OH310949280026OtherCARESOURCE
OH000000009496OtherANTHEM
OH0498465Medicare ID - Type Unspecified