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General NPI Number Information
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NPI Number | 1083888721
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Entity Type | Organization
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Legal Business Name | BRENT W FIDLER
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 455 E WONDER VIEW AVE STE. B1
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City | ESTES PARK
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State | CO
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Zip | 80517-9647
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Country | US
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Telephone | 970-577-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 455 E WONDER VIEW AVE STE. B1
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City | ESTES PARK
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State | CO
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Zip | 80517-9647
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Country | US
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Telephone | 970-577-1027
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. BRENT W FIDLER
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Credential | O.D.
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Telephone | 970-577-1027
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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 |
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License Number State |
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