Provider Demographics
NPI:1902288558
Name:BRUNS, NICHOLAS J (OD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:BRUNS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4499 TOWN CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3425
Mailing Address - Country:US
Mailing Address - Phone:810-733-7111
Mailing Address - Fax:810-733-7141
Practice Address - Street 1:4499 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3425
Practice Address - Country:US
Practice Address - Phone:810-733-7111
Practice Address - Fax:810-733-7141
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist