Provider Demographics
NPI:1457913527
Name:COLBURN, BRIAN (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:COLBURN
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 1:130037 GOOSE LORE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-7215
Mailing Address - Country:US
Mailing Address - Phone:308-672-3125
Mailing Address - Fax:
Practice Address - Street 1:329 W 40TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4634
Practice Address - Country:US
Practice Address - Phone:308-635-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist