Provider Demographics
NPI:1396725602
Name:COMPREHENSIVE OPHTHALMOLOGY, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE OPHTHALMOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-476-8602
Mailing Address - Street 1:275 HOLLANDER RD
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391
Mailing Address - Country:US
Mailing Address - Phone:952-476-8602
Mailing Address - Fax:952-476-8602
Practice Address - Street 1:3209 WEST 76TH ST
Practice Address - Street 2:#303
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-844-2020
Practice Address - Fax:952-844-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
639R1COOtherBCBS
C04155Medicare ID - Type Unspecified
639R1COOtherBCBS