Basic Information
| Provider Information | |||||||||
| NPI: | 1154424745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUNDIGE | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9401 N OAK TRFY | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641552233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164781230 | ||||||||
| FaxNumber: | 8163506801 | ||||||||
| Practice Location | |||||||||
| Address1: | 9401 N OAK TRFY | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641552233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164781230 | ||||||||
| FaxNumber: | 8163506801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 08/01/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 2002007672 | MO | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.