Provider Demographics
NPI:1659474120
Name:BRUJIC, MILE (OD)
Entity Type:Individual
Prefix:
First Name:MILE
Middle Name:
Last Name:BRUJIC
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 1:15 DARLYN DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402
Mailing Address - Country:US
Mailing Address - Phone:419-352-2502
Mailing Address - Fax:419-352-1281
Practice Address - Street 1:1222 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2664
Practice Address - Country:US
Practice Address - Phone:419-352-2505
Practice Address - Fax:419-352-1281
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5292 T2201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2335904Medicaid
OHU90519Medicare UPIN
OH4084371Medicare PIN
OH4084372Medicare PIN
OH00126388Medicare PIN