Provider Demographics
NPI:1619229952
Name:BRUCKER, KATRIN BRIANNE (OD)
Entity type:Individual
Prefix:DR
First Name:KATRIN
Middle Name:BRIANNE
Last Name:BRUCKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3144
Mailing Address - Country:US
Mailing Address - Phone:701-751-2330
Mailing Address - Fax:701-751-2338
Practice Address - Street 1:306 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3144
Practice Address - Country:US
Practice Address - Phone:701-751-2330
Practice Address - Fax:701-751-2338
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist