Provider Demographics
NPI:1972287548
Name:BRUEMMER, AGGIE R (OD)
Entity type:Individual
Prefix:
First Name:AGGIE
Middle Name:R
Last Name:BRUEMMER
Suffix:
Gender:F
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:PO BOX 774
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-0774
Mailing Address - Country:US
Mailing Address - Phone:417-869-3937
Mailing Address - Fax:417-869-0281
Practice Address - Street 1:640 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1016
Practice Address - Country:US
Practice Address - Phone:417-869-3937
Practice Address - Fax:417-869-0281
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023022208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist