Provider Demographics
NPI:1982683009
Name:BRUG, CAROLYN M (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:BRUG
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:3161 DIXIE HWY
Mailing Address - Street 2:STE D
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-1841
Mailing Address - Country:US
Mailing Address - Phone:859-341-8600
Mailing Address - Fax:859-341-3650
Practice Address - Street 1:3161 DIXIE HWY
Practice Address - Street 2:STE D
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1841
Practice Address - Country:US
Practice Address - Phone:859-341-8600
Practice Address - Fax:859-341-3650
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2015-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY1061DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK013140OtherCHAMPUS
KYKY1061OtherEYEMED
KY410030847OtherRR MEDICARE
KY000000033230OtherANTHEM
KYK013140OtherCHAMPUS
KY410030847OtherRR MEDICARE
KY000000033230OtherANTHEM