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General NPI Number Information
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NPI Number | 1821130428
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Entity Type | Individual
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Provider Name | MICHAEL GUY WISMANN O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8501 W BOWLES AVE
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City | LITTLETON
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State | CO
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Zip | 80123-9502
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Country | US
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Telephone | 303-972-6068
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Fax |
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Provider Business Mailing Address
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Address Line | 9760 HILLDALE DR
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City | MORRISON
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State | CO
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Zip | 80465-2334
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Country | US
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Telephone |
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Fax |
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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 | 1112
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License Number State | CO
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