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General NPI Number Information
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NPI Number | 1306960307
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Entity Type | Organization
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Legal Business Name | BROOKS OPTOMETRIC
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Dates
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Enumeration Date | 03/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6799 BISMARK RD STE D
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City | COLORADO SPRINGS
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State | CO
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Zip | 80922-1188
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Country | US
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Telephone | 719-574-2020
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Fax | 719-574-1391
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Provider Business Mailing Address
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Address Line | 6799 BISMARK RD STE D
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City | COLORADO SPRINGS
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State | CO
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Zip | 80922-1188
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Country | US
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Telephone | 719-574-2020
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Fax | 719-574-1391
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH J BROOKS
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Credential | OD
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Telephone | 719-574-2020
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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 | OPT1985
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License Number State | CO
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