Provider Demographics
NPI:1063482560
Name:BURLESON, CARRIE M (OD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:M
Last Name:BURLESON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:M
Other - Last Name:BREUSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:13605 XAVIER LN STE G
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-3603
Mailing Address - Country:US
Mailing Address - Phone:303-951-1820
Mailing Address - Fax:
Practice Address - Street 1:13605 XAVIER LN STE G
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-3603
Practice Address - Country:US
Practice Address - Phone:303-951-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2293152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU91862Medicare UPIN
CO804955Medicare PIN