MEDICARE: DR. DEAN TYSON BRYAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT2143	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2670540	OTHER	CO	AETNA
2	7520249	OTHER	CO	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154428787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN TYSON BRYAN O.D.

Provider Business Mailing Address
First Line	:	2525 S WADSWORTH BLVD
Second Line	:	101
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3273
Country	:	US
Telephone Number	:	303-986-5983
Fax Number	:	303-986-5473

Provider Business Practice Location Address
First Line	:	2525 S WADSWORTH BLVD
Second Line	:	101
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3273
Country	:	US
Telephone Number	:	303-986-5983
Fax Number	:	303-986-5473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	07/14/2010

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