Brian Dwight Grudem, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

LD1732000 Issued in MN

Practice address

4720 White Bear Pkwy
White Bear Lake, MN 55110-3336

Phone

(651) 426-2747

Fax

(651) 426-9838

NPI assigned

Aug 16, 2005

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eagan Eye Clinic LLCGroup PAC ID 0345220745, 48 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eagan Eye Clinic LLC

  • Optometrist
  • Eagan, MN
  • NPI 1477732337
  Medicare reassignment Care Compare group NPD
• Birch Lake Vision Group, LLC.

  dba Birch Lake Eye Clinic, Oak Tree Optical, Village Eye Clinic and Optica

  • Optometrist
  • White Bear Lake, MN
  • NPI 1609921899
  Authorized official Same address or phone
• Eagan Eye Clinic LLC

  • Optometrist
  • Becker, MN
  • NPI 1023615069
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1194717298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103336",
            "telephone_number": "651-426-2747",
            "fax_number": "651-426-9838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4720 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103336",
            "telephone_number": "651-426-2747",
            "fax_number": "651-426-9838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUDEM",
        "first_name": "BRIAN",
        "middle_name": "DWIGHT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "LD1732000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD RETIREM",
            "identifier": "P00124841",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02779",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0N456GR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "965400656001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP29577",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02690",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emmah Kaye Griswold, PA-C
• Kadi Groppoli
• Group Health, Inc. (HealthPartners White Bear Dental Clinic)
• Group Healthplan Inc (HealthPartners White Bear Lake Clinic)
• Groves Physical Therapy
• Thomas E Grzeskowiak, DDS
• Hannah Lucille Gueller
• Guided Mental Health
• Kent C Gulden, D.D.S. P.A.
• Wendy S Gulden, D.D.S. M.S.

• Optometrist in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.