Provider Demographics
NPI:1932234846
Name:BRUNNER, ANN
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 35TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3955
Mailing Address - Country:US
Mailing Address - Phone:970-356-0100
Mailing Address - Fax:970-356-0101
Practice Address - Street 1:2108 35TH AVE STE A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3955
Practice Address - Country:US
Practice Address - Phone:970-356-0100
Practice Address - Fax:970-356-0101
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0310600001OtherMEDICARE PROVIDER #