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General NPI Number Information
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NPI Number | 1003847559
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Entity Type | Organization
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Legal Business Name | ROBERT K BROWDER INC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 415 N GREENWOOD ST STE F
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City | PUEBLO
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State | CO
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Zip | 81003-3173
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Country | US
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Telephone | 719-561-4365
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Fax | 719-542-2140
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Provider Business Mailing Address
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Address Line | 415 N GREENWOOD ST STE F
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City | PUEBLO
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State | CO
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Zip | 81003-3173
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Country | US
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Telephone | 719-561-4365
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Fax | 719-542-2140
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT KENNETH BROWDER
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Credential | OD
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Telephone | 719-561-4365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 783
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License Number State | CO
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