Provider Demographics
NPI:1811909476
Name:BRUENING, GREGORY J (OD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:BRUENING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6751 N 72ND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1746
Mailing Address - Country:US
Mailing Address - Phone:402-572-2020
Mailing Address - Fax:402-572-2150
Practice Address - Street 1:6751 N 72ND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1746
Practice Address - Country:US
Practice Address - Phone:402-572-2020
Practice Address - Fax:402-572-2150
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1001152W00000X
IA02128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2200237OtherUHC OF THE MIDLANDS
NE93317OtherCOVENTRY
IA0514190Medicaid
NE06987OtherBCBS NE
NE47067295013Medicaid
IA96473OtherBCBS IA
NE22882OtherMIDLANDS CHOICE
NENEREX01660OtherMUTUAL OF OMAHA
NE47067295013Medicaid
NE93317OtherCOVENTRY
NE2200237OtherUHC OF THE MIDLANDS