Provider Demographics
NPI:1306926787
Name:BRUNS, JAMES EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:BRUNS
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 1:6180 STATE FARM DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2135
Mailing Address - Country:US
Mailing Address - Phone:707-584-7294
Mailing Address - Fax:707-584-4728
Practice Address - Street 1:6180 STATE FARM DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2135
Practice Address - Country:US
Practice Address - Phone:707-584-7294
Practice Address - Fax:707-584-4728
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5247T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0052470Medicaid
CA272432862Medicare UPIN
CASD0052470Medicaid