Provider Demographics
NPI:1316272651
Name:BRUNIG, AMY B (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:BRUNIG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HIGHLANDS BOULEVARD DR
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4383
Mailing Address - Country:US
Mailing Address - Phone:636-256-3285
Mailing Address - Fax:
Practice Address - Street 1:201 HIGHLANDS BOULEVARD DR
Practice Address - Street 2:VISION CENTER
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4383
Practice Address - Country:US
Practice Address - Phone:636-256-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist