MEDICARE: BRYAN VISION ASSOCIATES INC

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		CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C466928	OTHER	CO	MEDICARE PTIN

General Provider Information

NPI Number	:	1790943850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYAN VISION ASSOCIATES INC

Provider Business Mailing Address
First Line	:	2525 S WADSWORTH BLVD
Second Line	:	101
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3273
Country	:	US
Telephone Number	:	303-986-5983
Fax Number	:	303-986-5473

Provider Business Practice Location Address
First Line	:	2525 S WADSWORTH BLVD
Second Line	:	101
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3273
Country	:	US
Telephone Number	:	303-986-5983
Fax Number	:	303-986-5473

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. STACEY KRISTIN SPAULDING
Credential	:	OD
Telephone Number	:	303-986-5983

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	02/02/2012

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Directions to “BRYAN VISION ASSOCIATES INC ” Practice Location

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