Elliott Dale Brubaker, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2514 Issued in MN

Practice address

1270 Promenade PL Ste 120
Eagan, MN 55121-2537

Phone

(651) 452-8442

NPI assigned

Sep 6, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Optometric Services, LLC

  • Optometrist
  • Roseville, MN
  • NPI 1518010495
  NPD
• Elijah Institute

  • Mental Health Counselor
  • Lakeville, MN
  • NPI 1043133770
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1508969403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16224 HOMINY PATH",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550443817",
            "telephone_number": "612-240-3802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 PROMENADE PL STE 120",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551212537",
            "telephone_number": "651-452-8442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1270 Promenade Pl Ste 120",
            "address_purpose": "LOCATION",
            "city": "Eagan",
            "state": "MN",
            "postal_code": "551212537",
            "country_code": "US",
            "telephone_number": "651-451-1805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUBAKER",
        "first_name": "ELLIOTT",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latrice Brown-Chitou, CNP
• Ashley Studer Brown
• Jonshanique Brown
• Kaitlyn Diane Brown, PA
• Megan Louise Brozovich, DPT
• Eva Liana Bruestle, M.T.
• Tamara Bruns, CPHT
• Takiya Charissa Bryant
• Max Bubar, M.T.
• Sarah Beth Carlson Buckley, MD

• Optometrist in Eagan, MN
• Providers in Eagan, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.