Provider Demographics
NPI:1790943850
Name:BRYAN VISION ASSOCIATES INC
Entity Type:Organization
Organization Name:BRYAN VISION ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:KRISTIN
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-986-5983
Mailing Address - Street 1:2525 S WADSWORTH BLVD
Mailing Address - Street 2:101
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3273
Mailing Address - Country:US
Mailing Address - Phone:303-986-5983
Mailing Address - Fax:303-986-5473
Practice Address - Street 1:2525 S WADSWORTH BLVD
Practice Address - Street 2:101
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3273
Practice Address - Country:US
Practice Address - Phone:303-986-5983
Practice Address - Fax:303-986-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC466928OtherMEDICARE PTIN
CO466928Medicare PIN
COC466928OtherMEDICARE PTIN