Provider Demographics
NPI:1447431812
Name:BROWDER, ROBERT KENNETH (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KENNETH
Last Name:BROWDER
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 1:415 N GREENWOOD ST
Mailing Address - Street 2:STE F
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3173
Mailing Address - Country:US
Mailing Address - Phone:719-561-4365
Mailing Address - Fax:719-542-2140
Practice Address - Street 1:415 N GREENWOOD ST
Practice Address - Street 2:STE F
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3173
Practice Address - Country:US
Practice Address - Phone:719-561-4365
Practice Address - Fax:719-542-2140
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79600549Medicaid
CO79600549Medicaid
COC801792Medicare PIN