Provider Demographics
NPI:1932626033
Name:BETH BRUENING PC
Entity Type:Organization
Organization Name:BETH BRUENING PC
Other - Org Name:BRUENING EYE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUENING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-217-4500
Mailing Address - Street 1:PO BOX 3566
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-3566
Mailing Address - Country:US
Mailing Address - Phone:605-217-4500
Mailing Address - Fax:605-217-4503
Practice Address - Street 1:5500 SERGEANT ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4716
Practice Address - Country:US
Practice Address - Phone:605-217-4500
Practice Address - Fax:605-217-4503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH BRUENING PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1840152W00000X
IA28135207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty