MEDICARE: DR. DONALD R BURRITT 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	1288	CO
2	152W00000X	Optometrist	301T	WY

General Provider Information

NPI Number	:	1699872846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD R BURRITT O.D.

Provider Business Mailing Address
First Line	:	7931 BAYSIDE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8949
Country	:	US
Telephone Number	:	970-225-2277
Fax Number	:

Provider Business Practice Location Address
First Line	:	7931 BAYSIDE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8949
Country	:	US
Telephone Number	:	970-225-2277
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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