Basic Information
| Provider Information | |||||||||
| NPI: | 1811909476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUENING | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6751 N 72ND ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681221746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722020 | ||||||||
| FaxNumber: | 4025722150 | ||||||||
| Practice Location | |||||||||
| Address1: | 6751 N 72ND ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681221746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722020 | ||||||||
| FaxNumber: | 4025722150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1001 | NE | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 02128 | IA | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 2200237 | 01 | NE | UHC OF THE MIDLANDS | OTHER | 93317 | 01 | NE | COVENTRY | OTHER | 0514190 | 05 | IA | MEDICAID | 06987 | 01 | NE | BCBS NE | OTHER | 47067295013 | 05 | NE | MEDICAID | 96473 | 01 | IA | BCBS IA | OTHER | 22882 | 01 | NE | MIDLANDS CHOICE | OTHER | NEREX01660 | 01 | NE | MUTUAL OF OMAHA | OTHER |