Healthcare Provider Details

I. General information

NPI: 1619274198
Provider Name (Legal Business Name): BRET W HARRISON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 TUTT BLVD
COLORADO SPRINGS CO
80923-3575
US

IV. Provider business mailing address

6140 TUTT BLVD
COLORADO SPRINGS CO
80923-3575
US

V. Phone/Fax

Practice location:
  • Phone: 719-268-1010
  • Fax:
Mailing address:
  • Phone: 719-268-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT1128
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOPT1128
License Number StateCO

VIII. Authorized Official

Name: MR. BRET W HARRISON
Title or Position: DOCTOR/OWNER
Credential: O.D.
Phone: 719-268-1010