MEDICARE: BRET W HARRISON

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	332H00000X	Eyewear Supplier	OPT1128	CO
2	152W00000X	Optometrist	OPT1128	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104898220	OTHER	CO	NPI

General Provider Information

NPI Number	:	1619274198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRET W HARRISON

Provider Business Mailing Address
First Line	:	6140 TUTT BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3575
Country	:	US
Telephone Number	:	719-268-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	6140 TUTT BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3575
Country	:	US
Telephone Number	:	719-268-1010
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	MR. BRET W HARRISON
Credential	:	O.D.
Telephone Number	:	719-268-1010

Provider Enumeration Date	:	02/18/2011
Last Update Date	:	03/08/2016

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Directions to “BRET W HARRISON ” Practice Location

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