Provider Demographics
NPI:1508437906
Name:TANNER, BRUCE
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:TANNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101C SUNDIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-9095
Mailing Address - Country:US
Mailing Address - Phone:719-687-3937
Mailing Address - Fax:719-687-9308
Practice Address - Street 1:101C SUNDIAL DR STE C
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-9095
Practice Address - Country:US
Practice Address - Phone:719-687-3937
Practice Address - Fax:719-687-9308
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3683152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist