Provider Demographics
NPI:1023873122
Name:LOVELL, BRIANA RENEE (OD)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:RENEE
Last Name:LOVELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 OUTLOOK TRL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-9687
Mailing Address - Country:US
Mailing Address - Phone:815-370-6856
Mailing Address - Fax:
Practice Address - Street 1:1855 29TH ST # 1E-1156
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1065
Practice Address - Country:US
Practice Address - Phone:720-565-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist