Paul Christian Bruderer, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4942085-9934 Issued in UT

Practice address

2782 S 5600 W Ste 101
West Valley City, UT 84120-5592

Phone

(801) 969-9999

Fax

(801) 746-1007

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

International American University at Puerto Rico - School of Optometry, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tanner Memorial ClinicGroup PAC ID 4284547985, 251 clinicians

Aeg Utah Professional IncGroup PAC ID 2062918618, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Networks

• UT PPO

Interoperability endpoints

• Direct secure messaging: paul.bruderer.p1@direct.tannerclinic.nextgenshare.com

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

• Aeg Utah Professional Inc

  • Optometrist
  • Logan, UT
  • NPI 1154212777
  Medicare reassignment Care Compare group NPD
• Paul C Bruderer O D P C

  • Optometrist
  • West Valley City, UT
  • NPI 1427241843
  Medicare reassignment NPD Authorized official
• Tanner Memorial Clinic

  • Internal Medicine Physician
  • Layton, UT
  • NPI 1447239355
  Medicare reassignment Care Compare group NPD
• Tanner Memorial Clinic

  • Multi-Specialty Clinic/Center
  • Layton, UT
  • NPI 1538951165
  NPD
• Tanner Memorial Clinic

  • Family Medicine Physician
  • Layton, UT
  • NPI 1760934533
  NPD

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1316956576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2782 S 5600 W STE 101",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841205592",
            "telephone_number": "801-969-9999",
            "fax_number": "801-746-1007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2782 S 5600 W STE 101",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841205592",
            "telephone_number": "801-969-9999",
            "fax_number": "801-746-1007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUDERER",
        "first_name": "PAUL",
        "middle_name": "CHRISTIAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "4942085-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Briggs, LCSW
• Thomas Karl Broadbent
• Jonathan David Brower
• Todd E Brown, PT
• Kyla Brownell
• Lisa Ann Bullough, RPH
• Melissa Burgos
• William H Burleigh, DPM
• Niel Burnett
• Rebecca L Burrage, APRN

• Optometrist in West Valley City, UT
• Providers in West Valley City, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; 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.