MEDICARE: BRIGHTON EYE ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1123	CO
2	152W00000X	Optometrist	645	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598788564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTON EYE ASSOCIATES PC

Provider Business Mailing Address
First Line	:	1001 EAST BRIDGE STREET
Second Line	:	SUITE A
City	:	BRIGHTON
State	:	CO
Zip	:	80601-2276
Country	:	US
Telephone Number	:	303-659-3036
Fax Number	:	303-659-0053

Provider Business Practice Location Address
First Line	:	1001 EAST BRIDGE STREET
Second Line	:	SUITE A
City	:	BRIGHTON
State	:	CO
Zip	:	80601-2276
Country	:	US
Telephone Number	:	303-659-3036
Fax Number	:	303-659-0053

Authorized Official
Title or Position	:	OPTOMETRIST PRESIDENT OWNER
Name	:	DR. RODNEY DALE FAIR
Credential	:	OD
Telephone Number	:	303-659-3036

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	06/25/2008

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