Provider Demographics
NPI:1922166586
Name:BRUCE H BRUMM MD PC
Entity Type:Organization
Organization Name:BRUCE H BRUMM MD PC
Other - Org Name:BRUMM EYE & LASERVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-572-2020
Mailing Address - Street 1:17001 LAKESIDE HILLS PLZ
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4670
Mailing Address - Country:US
Mailing Address - Phone:402-934-7700
Mailing Address - Fax:402-934-2555
Practice Address - Street 1:17001 LAKESIDE HILLS PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4670
Practice Address - Country:US
Practice Address - Phone:402-934-7700
Practice Address - Fax:402-934-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13621207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NECN7021OtherRAILROAD MEDICARE GROUP
NE098260Medicare ID - Type UnspecifiedGROUP NUMBER
IAI5664Medicare PIN