Provider Demographics
NPI:1457467409
Name:BUCHANAN, STEVEN MATTHEW (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MATTHEW
Last Name:BUCHANAN
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 1:5018 PETRIFIED FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2911
Mailing Address - Country:US
Mailing Address - Phone:901-355-2699
Mailing Address - Fax:
Practice Address - Street 1:8540 SCARBOROUGH DR
Practice Address - Street 2:SUITE 240
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-495-5904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC806807Medicare PIN