Basic Information
| Provider Information | |||||||||
| NPI: | 1154500726 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUMM | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6751 N 72ND ST | ||||||||
| Address2: | STE. 105 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681221746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722020 | ||||||||
| FaxNumber: | 4025722150 | ||||||||
| Practice Location | |||||||||
| Address1: | 6751 N 72ND ST | ||||||||
| Address2: | STE. 105 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681221746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722020 | ||||||||
| FaxNumber: | 4025722150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2007 | ||||||||
| LastUpdateDate: | 12/10/2012 | ||||||||
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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 | 4301091926 | MI | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 25802 | NE | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 40169 | IA | N | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.