Healthcare Provider Details

I. General information

NPI: 1083690226
Provider Name (Legal Business Name): BRETT NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FT CARSON CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR
FT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7450
  • Fax:
Mailing address:
  • Phone: 719-526-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01059150A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number49842
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: