Provider Demographics
NPI:1437498763
Name:O'BRIEN, DYLAN (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1411
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:CO
Mailing Address - Zip Code:80535-1411
Mailing Address - Country:US
Mailing Address - Phone:970-624-9019
Mailing Address - Fax:
Practice Address - Street 1:145 W SWALLOW RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2500
Practice Address - Country:US
Practice Address - Phone:970-624-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician