Provider Demographics
NPI:1962503524
Name:BUGAJSKI, KIMBERLEY ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:BUGAJSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 OLD COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6210
Mailing Address - Country:US
Mailing Address - Phone:763-545-8850
Mailing Address - Fax:763-544-1257
Practice Address - Street 1:10600 OLD COUNTY ROAD 15
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6210
Practice Address - Country:US
Practice Address - Phone:763-545-8850
Practice Address - Fax:763-544-1257
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLD2371000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN977521015898OtherPREFERRED ONE
MN417R5BUOtherBCBS
MN751525100Medicaid
MN2200102OtherMEDICA
MNU21145Medicare UPIN
MN417R5BUOtherBCBS