Provider Demographics
NPI:1568455400
Name:FAIR, RODNEY D (OD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:D
Last Name:FAIR
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 1:1001 E BRIDGE ST STE A
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2276
Mailing Address - Country:US
Mailing Address - Phone:303-659-3036
Mailing Address - Fax:303-659-0053
Practice Address - Street 1:1001 E BRIDGE ST STE A
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2275
Practice Address - Country:US
Practice Address - Phone:303-659-3036
Practice Address - Fax:303-659-0053
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08011231Medicaid
CO1568455400OtherNPI NUMBER
COC800833Medicare PIN
CO08011231Medicaid
CO0353080001Medicare NSC