Provider Demographics
NPI:1558353045
Name:GEHLER, BRANT ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANT
Middle Name:ROBERT
Last Name:GEHLER
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 1:2485 E PIKES PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6004
Mailing Address - Country:US
Mailing Address - Phone:719-634-2001
Mailing Address - Fax:719-634-2211
Practice Address - Street 1:2485 E PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6004
Practice Address - Country:US
Practice Address - Phone:719-634-2001
Practice Address - Fax:719-634-2211
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08014581Medicaid
CO08014581Medicaid
COCF3023Medicare ID - Type Unspecified