Provider Demographics
NPI:1467946640
Name:BRUNER, REEMA BHAGAT (OD)
Entity Type:Individual
Prefix:
First Name:REEMA
Middle Name:BHAGAT
Last Name:BRUNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:REEMA
Other - Middle Name:K
Other - Last Name:BHAGAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:370 HOUBOLT RD STE 102
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8303
Practice Address - Country:US
Practice Address - Phone:157-299-1438
Practice Address - Fax:815-729-1580
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002662152W00000X
IL046011729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist