Healthcare Provider Details

I. General information

NPI: 1497828776
Provider Name (Legal Business Name): MICHAEL G PHARRIS JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2857 E FOUNTAIN BLVD
COLORADO SPRINGS CO
80910-2312
US

IV. Provider business mailing address

2221 EAST BIJOU SUITE 100
COLORADO SPRINGS CO
80909
US

V. Phone/Fax

Practice location:
  • Phone: 719-329-1221
  • Fax: 719-329-1511
Mailing address:
  • Phone: 719-576-1850
  • Fax: 719-955-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1462
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1462
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: