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General NPI Number Information
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NPI Number | 1740452614
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Entity Type | Individual
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Provider Name | GARY EDWARD BIRCHAM OD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 4804 WAGONTRAIL COURT
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City | PARKER
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State | CO
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Zip | 80134
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Country | US
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Telephone | 303-284-0134
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Fax | 303-284-0571
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Provider Business Mailing Address
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Address Line | 4804 WAGONTRAIL COURT
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City | PARKER
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State | CO
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Zip | 80134
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Country | US
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Telephone | 303-818-7150
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Fax | 303-284-0571
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1431
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License Number State | CO
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