Provider Demographics
NPI:1154492783
Name:BROWNSON, ROBERT S (OD, PC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:BROWNSON
Suffix:
Gender:M
Credentials:OD, PC
Other - Prefix:DR
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:BROWNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD, PC
Mailing Address - Street 1:2737 CROSSROADS BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-3954
Mailing Address - Country:US
Mailing Address - Phone:970-243-9681
Mailing Address - Fax:970-243-9155
Practice Address - Street 1:2737 CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-3954
Practice Address - Country:US
Practice Address - Phone:970-243-9681
Practice Address - Fax:970-243-9155
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4304420001OtherDMERC
CO38122031Medicaid
CO450978Medicare PIN
CO38122031Medicaid