Provider Demographics
NPI:1801886635
Name:BRYANT, JOHN ALLEN (O D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
Last Name:BRYANT
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
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Mailing Address - Street 1:1130 LAKE PLAZA DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3594
Mailing Address - Country:US
Mailing Address - Phone:719-219-3819
Mailing Address - Fax:719-219-0411
Practice Address - Street 1:14991 E HAMPDEN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3983
Practice Address - Country:US
Practice Address - Phone:303-963-9561
Practice Address - Fax:303-963-0713
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO960152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08009607Medicaid
CO18591Medicare UPIN
COF2933Medicare PIN