MEDICARE: EDGE OPTICS LLC

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

General Provider Information

NPI Number	:	1184562795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGE OPTICS LLC

Provider Business Mailing Address
First Line	:	602 N CLEVELAND AVE
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-6009
Country	:	US
Telephone Number	:	970-541-1443
Fax Number	:	970-913-0880

Provider Business Practice Location Address
First Line	:	602 N CLEVELAND AVE
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-6009
Country	:	US
Telephone Number	:	970-541-1443
Fax Number	:	970-913-0880

Authorized Official
Title or Position	:	DIRECTOR/OPTOMETRIST
Name	:	MASON T BRYANT
Credential	:	OD
Telephone Number	:	970-682-2627

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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