Provider Demographics
NPI:1003868621
Name:BRUNEAU, SCOTT FRANCIS (OD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:FRANCIS
Last Name:BRUNEAU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E RIVERVIEW EXPY
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5483
Mailing Address - Country:US
Mailing Address - Phone:715-423-1340
Mailing Address - Fax:715-423-1444
Practice Address - Street 1:1100 E RIVERVIEW EXPY
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5483
Practice Address - Country:US
Practice Address - Phone:715-423-1340
Practice Address - Fax:715-423-1444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2719-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV38606200Medicaid
WIU73055Medicare UPIN
WI11-87832Medicare ID - Type UnspecifiedMEDICARE ID