Provider Demographics
NPI:1841421575
Name:BRUECKNER, CHRISTOPHER BRYANT (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BRYANT
Last Name:BRUECKNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER
Mailing Address - Street 2:9040 JACKSON AVENUE
Mailing Address - City:JBLM
Mailing Address - State:WA
Mailing Address - Zip Code:98431-5000
Mailing Address - Country:US
Mailing Address - Phone:253-968-4664
Mailing Address - Fax:253-968-3168
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-5000
Practice Address - Country:US
Practice Address - Phone:253-968-4664
Practice Address - Fax:253-968-3168
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI3318152W00000X
OR3318ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist