IndividualActive
Brian Grudem, O.D.
NPI 1194717298 · Optometrist · White Bear Lake, MN
Provider details
- NPI number
- 1194717298
- Entity type
- Individual
- Primary specialty
- OptometristEye and Vision Services Providers
- Credential
- O.D.
- Sex
- Male
- License
- LD1732000 (MN)
Specialties & taxonomies
Eye and Vision Services Providers
Practice location
4720 White Bear Pkwy
White Bear Lake, MN 55110-3336
Phone: (651) 426-2747
Fax: (651) 426-9838
Approximate (ZIP-level) locationGet directions
Mailing address
4720 White Bear Pkwy
White Bear Lake, MN 55110-3336
Registry dates
- Enumerated
- 2005-08-16
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.