Provider Demographics
NPI:1285663302
Name:BORSTAD, BRETT JOSEF (OD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:JOSEF
Last Name:BORSTAD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8383 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3007
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92282725Medicaid
CO025972OtherKAISER COMMERCIAL NUMBER
CO43718000OtherDAVIS
CO11372767OtherROCKY MOUNTAIN HEALTH PLA
CO805234OtherMEDICARE GROUP
COB01505582OtherCLARITY
CO204611OtherEYEMED
CO2292OtherSTATE LICENSE
CO92282725Medicaid
CO393499YK5YMedicare PIN