Provider Demographics
NPI:1780855379
Name:BRUSATTI EYE CARE, LLC
Entity Type:Organization
Organization Name:BRUSATTI EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUSATTI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-776-5606
Mailing Address - Street 1:5143 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3009
Mailing Address - Country:US
Mailing Address - Phone:314-664-3937
Mailing Address - Fax:314-802-4919
Practice Address - Street 1:5143 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3009
Practice Address - Country:US
Practice Address - Phone:314-776-5606
Practice Address - Fax:314-802-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier