NPIMap

Organization Active NPI

Brubaker Vision LLC

  • Optometrist
  • Burnsville, MN
National Provider Identifier
1639555261
Registry record updated Aug 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2514 Issued in MN
Legal business name
BRUBAKER VISION LLC
Practice address
11712 Galtier Dr
Burnsville, MN 55337-3208
Phone
(612) 240-3814
NPI assigned
Aug 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2015

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

Authorized official

Name
Elliott Dale Brubaker, O.D.
Title
President
Phone
(612) 240-3814

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2514 MN Primary

Addresses

Primary practice location

11712 Galtier Dr
Burnsville, MN 55337-3208

Mailing address

7835 150TH St W
Apple Valley, MN 55124-7181
Phone (952) 431-9709

National Provider Directory

National Provider Directory
Tax ID family
Brubaker Vision2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1438732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438732800000",
    "number": "1639555261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7835 150TH ST W",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247181",
            "telephone_number": "952-431-9709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11712 GALTIER DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553373208",
            "telephone_number": "612-240-3814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUBAKER VISION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-05",
        "last_updated": "2015-08-05",
        "status": "A",
        "authorized_official_last_name": "BRUBAKER",
        "authorized_official_first_name": "ELLIOTT",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-240-3814",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; 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.