Provider Demographics
NPI:1356329338
Name:BUSETH, BRICKER B (OD)
Entity Type:Individual
Prefix:DR
First Name:BRICKER
Middle Name:B
Last Name:BUSETH
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 1:2500 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9376
Mailing Address - Country:US
Mailing Address - Phone:517-262-0318
Mailing Address - Fax:
Practice Address - Street 1:2500 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-9376
Practice Address - Country:US
Practice Address - Phone:517-262-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3336152W00000X
MI4901003336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900C876200OtherBCBS OF MI
MIOM22130Medicare ID - Type Unspecified
MIU13089Medicare UPIN