Provider Demographics
NPI:1376539734
Name:BRUESS, RICHARD D (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:BRUESS
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 1:6545 GUNPARK DRIVE
Mailing Address - Street 2:STE 250
Mailing Address - City:BOULDER,
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3350
Mailing Address - Country:US
Mailing Address - Phone:303-530-1973
Mailing Address - Fax:303-530-1973
Practice Address - Street 1:6545 GUNPARK DRIVE
Practice Address - Street 2:STE 250
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3350
Practice Address - Country:US
Practice Address - Phone:303-530-1973
Practice Address - Fax:303-530-1973
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1549152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COBRR33595OtherBLUE CROSS BLUE SHIELD OF COLORADO
CO5816600001Medicare NSC
COU38960Medicare UPIN
COC805243Medicare PIN