Provider Demographics
NPI:1811224132
Name:BRUEGGEMANN, JEREMY KYLE (OD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:KYLE
Last Name:BRUEGGEMANN
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 1:7316 CAVE HOLW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 E 41ST ST
Practice Address - Street 2:406
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4810
Practice Address - Country:US
Practice Address - Phone:469-693-1426
Practice Address - Fax:512-450-0421
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7467TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist