Provider Demographics
NPI:1619274198
Name:BRET W HARRISON
Entity Type:Organization
Organization Name:BRET W HARRISON
Other - Org Name:BRET W. HARRISON O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-268-1010
Mailing Address - Street 1:6140 TUTT BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3575
Mailing Address - Country:US
Mailing Address - Phone:719-268-1010
Mailing Address - Fax:
Practice Address - Street 1:6140 TUTT BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3575
Practice Address - Country:US
Practice Address - Phone:719-268-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRET W. HARRISON O.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-18
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT1128152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1104898220OtherNPI