MEDICARE: MICHAEL G PHARRIS JR. OD

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	152WP0200X	Pediatric Optometrist	1462	CO
2	152W00000X	Optometrist	1462	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497828776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL G PHARRIS JR. OD

Provider Business Mailing Address
First Line	:	2221 EAST BIJOU
Second Line	:	SUITE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909
Country	:	US
Telephone Number	:	719-576-1850
Fax Number	:	719-955-3470

Provider Business Practice Location Address
First Line	:	2857 E FOUNTAIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-2312
Country	:	US
Telephone Number	:	719-329-1221
Fax Number	:	719-329-1511

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	10/20/2021

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