MEDICARE: DR. SUSAN MARY BRUNNETT 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	1297	CO

General Provider Information

NPI Number	:	1982741658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MARY BRUNNETT O.D.

Provider Business Mailing Address
First Line	:	8925 RIDGELINE BLVD. #107
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129
Country	:	US
Telephone Number	:	303-791-2727
Fax Number	:	303-791-2529

Provider Business Practice Location Address
First Line	:	8925 RIDGELINE BLVD STE 107
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-2502
Country	:	US
Telephone Number	:	303-791-2727
Fax Number	:	303-791-2529

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	12/11/2012

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