Provider Demographics
NPI:1598788564
Name:BRIGHTON EYE ASSOCIATES PC
Entity Type:Organization
Organization Name:BRIGHTON EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-659-3036
Mailing Address - Street 1:1001 EAST BRIDGE STREET
Mailing Address - Street 2:SUITE A
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 EAST BRIDGE STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2276
Practice Address - Country:US
Practice Address - Phone:303-659-3036
Practice Address - Fax:303-659-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO645152W00000X
CO1123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08006454Medicaid
CO08011231Medicaid
CO04012282Medicaid
CO04012282Medicaid
CO08011231Medicaid
CO0353080001Medicare NSC
T60838Medicare UPIN
CO800833Medicare PIN
CO800834Medicare ID - Type Unspecified